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General NPI Number Information
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NPI Number | 1891491866
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Entity Type | Organization
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Legal Business Name | CHILI FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 4369 BUFFALO RD STE A
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City | NORTH CHILI
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State | NY
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Zip | 14514-1236
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Country | US
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Telephone | 585-488-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 5908 TWEED TRL
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City | FARMINGTON
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State | NY
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Zip | 14425-8803
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Country | US
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Telephone | 716-553-7696
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | SANEL SADIBASIC
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Credential | DDS
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Telephone | 716-553-7696
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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