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General NPI Number Information
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NPI Number | 1639592959
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Entity Type | Organization
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Legal Business Name | D&G DENTISTRY, NY PA
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 3083 WILLIAM ST SUITE 3
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City | CHEEKTOWAGA
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State | NY
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Zip | 14227-1933
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Country | US
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Telephone | 917-804-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 3083 WILLIAM ST SUITE 3
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City | CHEEKTOWAGA
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State | NY
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Zip | 14227-1933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | STUART GOFF
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Credential | DDS
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Telephone | 917-804-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 049947
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License Number State | NY
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