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General NPI Number Information
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NPI Number | 1144730649
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1800 MAPLE RD STE 200
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2749
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Country | US
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Telephone | 716-688-7712
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Fax | 716-688-4719
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Provider Business Mailing Address
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Address Line | 1800 MAPLE RD STE 200
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2749
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Country | US
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Telephone | 716-688-7712
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. PAUL CREIGHTON
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Credential | DDS
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Telephone | 716-688-7712
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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 | 057971
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 31086
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 045762
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 058438
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 050946
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 040579
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License Number State | NY
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