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General NPI Number Information
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NPI Number | 1407502537
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Entity Type | Organization
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Legal Business Name | BUFFALO ROAD DENTAL LLC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 4820 BUFFALO RD
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City | ERIE
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State | PA
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Zip | 16510-2302
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Country | US
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Telephone | 814-899-0444
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Fax | 814-898-2403
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Provider Business Mailing Address
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Address Line | PO BOX 734753
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City | DALLAS
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State | TX
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Zip | 75373-4753
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Country | US
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Telephone | 814-899-0444
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Fax | 814-898-2403
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Authorized Official
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Title or Position | LEAD OF CREDENTIALING
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Name | VICENTA REYES
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Credential |
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Telephone | 972-869-3789
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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 |
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License Number State |
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