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General NPI Number Information
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NPI Number | 1306859483
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Entity Type | Individual
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Provider Name | CHARLES ALAN MATLACH
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 8397 BOSTON STATE RD
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City | BOSTON
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State | NY
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Zip | 14025-9651
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Country | US
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Telephone | 716-941-5433
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Fax | 716-941-5972
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Provider Business Mailing Address
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Address Line | 5281 VIA DEL SOLE
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221
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Country | US
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Telephone | 716-636-8215
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Fax | 716-688-2984
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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 | NY 32221
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License Number State | NY
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