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General NPI Number Information
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NPI Number | 1770778441
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Entity Type | Organization
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Legal Business Name | GENENE CROFUT DDS, PLLC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 2715 MILLERSPORT HWY
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City | GETZVILLE
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State | NY
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Zip | 14068-1222
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Country | US
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Telephone | 716-688-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 2715 MILLERSPORT HWY
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City | GETZVILLE
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State | NY
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Zip | 14068-1222
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Country | US
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Telephone | 716-688-4501
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GENENE CROFUT
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Credential | DDS
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Telephone | 716-688-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051154
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License Number State | NY
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