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General NPI Number Information
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NPI Number | 1770975880
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Entity Type | Organization
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Legal Business Name | GROWING SMILES PEDIATRIC & ADOLESCENT DENTISTRY, PLLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 6501 TRANSIT RD SUITE B
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City | EAST AMHERST
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State | NY
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Zip | 14051-1427
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Country | US
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Telephone | 716-580-3580
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Fax | 716-580-3580
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Provider Business Mailing Address
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Address Line | 6501 TRANSIT RD SUITE B
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City | EAST AMHERST
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State | NY
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Zip | 14051-1427
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Country | US
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Telephone | 716-580-3580
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Fax | 716-580-3580
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. AMANDA CRYAN
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Credential | DDS
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Telephone | 716-580-3580
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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 | 052008
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License Number State | NY
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