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General NPI Number Information
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NPI Number | 1598965691
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Entity Type | Organization
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Legal Business Name | CHESTER J. GARY, DDS AND MARK D. POWALSKI, DDS, PC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 2197 GEORGE URBAN BLVD
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City | DEPEW
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State | NY
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Zip | 14043-1960
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Country | US
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Telephone | 716-683-7443
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Fax | 716-684-3597
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Provider Business Mailing Address
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Address Line | 2197 GEORGE URBAN BLVD
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City | DEPEW
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State | NY
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Zip | 14043-1960
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Country | US
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Telephone | 716-683-7443
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Fax | 716-684-3597
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Authorized Official
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Title or Position | CORPORATE SHAREHOLDER
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Name | DR. CHESTER JOSEPH GARY
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Credential | DDS
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Telephone | 716-683-7443
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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 | 41403
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33932
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License Number State | NY
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