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General NPI Number Information
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NPI Number | 1508067059
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY DENTAL, PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 117 MAIN ST
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City | SALAMANCA
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State | NY
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Zip | 14779-1529
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Country | US
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Telephone | 716-945-7500
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Fax | 716-945-7774
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Provider Business Mailing Address
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Address Line | 117 MAIN ST
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City | SALAMANCA
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State | NY
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Zip | 14779-1529
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Country | US
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Telephone | 716-945-7500
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Fax | 716-945-7774
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRACY CULVER
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Credential |
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Telephone | 716-945-7500
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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 | 043623-1
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License Number State | NY
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