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General NPI Number Information
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NPI Number | 1841654571
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Entity Type | Organization
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Legal Business Name | APPLEGATE DENTAL
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 777 HOPKINS RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2320
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Country | US
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Telephone | 716-689-8882
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Fax | 716-689-6183
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Provider Business Mailing Address
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Address Line | 777 HOPKINS RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2320
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Country | US
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Telephone | 716-689-8882
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Fax | 716-689-6183
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEE M SHAINBROWN
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Credential | D.D.S.
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Telephone | 716-689-8882
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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 | 052059
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License Number State | NY
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