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General NPI Number Information
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NPI Number | 1972744167
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Entity Type | Organization
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Legal Business Name | GREATER NIAGARA ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 552 3RD ST
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City | NIAGARA FALLS
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State | NY
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Zip | 14301-1072
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Country | US
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Telephone | 716-282-0285
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Fax |
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Provider Business Mailing Address
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Address Line | 9744 COBBLESTONE DR
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City | CLARENCE
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State | NY
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Zip | 14031-2443
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Country | US
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Telephone | 716-830-9935
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANIL BALKRISHNA NIGALYE
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Credential | DDS, MD
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Telephone | 716-830-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 049563
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License Number State | NY
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