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General NPI Number Information
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NPI Number | 1689710204
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Entity Type | Organization
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Legal Business Name | WILLIAMSVILLE DENTAL GROUP
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 N UNION RD SUITE 1
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221
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Country | US
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Telephone | 716-633-1187
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Fax | 716-633-4276
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Provider Business Mailing Address
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Address Line | 40 N UNION RD SUITE 1
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221
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Country | US
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Telephone | 716-633-1187
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Fax | 716-633-4276
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES H ELY
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Credential | DDS
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Telephone | 716-633-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 028311
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License Number State | NY
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