=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760522833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAZIANO & TAGOURI LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8201 MAIN ST SUITE 5
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-6046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-630-9999
-----------------------------------------------------
Fax | 716-630-6677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8201 MAIN ST. SUITE 5
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-630-9999
-----------------------------------------------------
Fax | 716-630-6677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. HESHAM ELTAGOURI
-----------------------------------------------------
Credential | DMD., MDS.
-----------------------------------------------------
Telephone | 716-630-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------