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General NPI Number Information
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NPI Number | 1013211226
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Entity Type | Organization
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Legal Business Name | VILLAGE DENTAL ACQUISITION, PLLC
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 5132 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4623
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Country | US
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Telephone | 716-632-2545
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Fax |
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Provider Business Mailing Address
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Address Line | 5132 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4623
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Country | US
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Telephone | 716-632-2545
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN B GOLDSTEIN
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Credential | DDS
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Telephone | 716-632-2545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 053977
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0494591
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License Number State | NY
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