=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750580973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT ANTHONY CHMIEL D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2007
-----------------------------------------------------
Last Update Date | 03/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 MAPLE RD SUITE #3
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-634-4900
-----------------------------------------------------
Fax | 716-633-5800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 MAPLE RD SUITE #3
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-634-4900
-----------------------------------------------------
Fax | 716-633-5800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 043543
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8249
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------