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General NPI Number Information
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NPI Number | 1144745472
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Entity Type | Individual
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Provider Name | KEVIN SCOTT MANZELLA DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4306 SENECA ST
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City | WEST SENECA
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State | NY
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Zip | 14224-3169
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Country | US
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Telephone | 716-337-5066
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Fax | 716-677-5413
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Provider Business Mailing Address
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Address Line | 327 EUCLID AVE
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City | KENMORE
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State | NY
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Zip | 14217-2903
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Country | US
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Telephone | 716-785-4684
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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 | 059107-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 059107-1
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License Number State | NY
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