=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033777461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOBIAS W. CORCORAN DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2019
-----------------------------------------------------
Last Update Date | 08/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 OAKWOOD AVE
-----------------------------------------------------
City | EAST AURORA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14052-2354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-710-2888
-----------------------------------------------------
Fax | 716-805-7001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 607 OAKWOOD AVE
-----------------------------------------------------
City | EAST AURORA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14052-2354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-710-2888
-----------------------------------------------------
Fax | 716-805-7001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MELANIE SPAHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-710-2888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------