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General NPI Number Information
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NPI Number | 1295183606
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Entity Type | Individual
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Provider Name | BLAIR BRAUNSTEIN
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Gender | Male
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 6225 W QUAKER ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2641
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Country | US
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Telephone | 716-667-2030
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Fax | 716-667-2034
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Provider Business Mailing Address
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Address Line | 6225 W QUAKER ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2641
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Country | US
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Telephone | 716-667-2030
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Fax | 716-667-2034
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 057514
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License Number State | NY
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