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General NPI Number Information
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NPI Number | 1023165636
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Entity Type | Individual
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Provider Name | PAMELA ANN GAMBACORTA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3714 ABBOTT RD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1713
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Country | US
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Telephone | 716-823-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 FOXWOOD LN
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-7370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 047505-1
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License Number State | NY
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