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General NPI Number Information
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NPI Number | 1730403924
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Entity Type | Organization
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Legal Business Name | NORTH TONAWANDA FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 301 MEADOW DR
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2819
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Country | US
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Telephone | 716-692-2273
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Fax | 716-692-2211
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Provider Business Mailing Address
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Address Line | 301 MEADOW DR
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2819
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Country | US
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Telephone | 716-692-2273
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Fax | 716-692-2211
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Authorized Official
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Title or Position | PATIENT CARE COORDINATOR
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Name | ANGELA MICHELLE VACANTI
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Credential |
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Telephone | 716-692-2273
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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 | 057366
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License Number State | NY
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