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General NPI Number Information
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NPI Number | 1396438784
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Entity Type | Individual
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Provider Name | RUBELISA CANDIDO GOMES DE OLIVEIRA
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 250 SQUIRE HALL RM 250A
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City | BUFFALO
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State | NY
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Zip | 14214-8006
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Country | US
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Telephone | 716-829-6294
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Fax |
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Provider Business Mailing Address
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Address Line | 70 GLENDON PLACE UNIF F
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City | BUFFALO
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State | NY
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Zip | 14221
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Country | US
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Telephone | 859-536-4891
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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 | 000139
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License Number State | NY
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