MEDICARE: JACQUELINE SZCZUPAKOWSKI DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1033764741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE SZCZUPAKOWSKI DDS, PLLC

Provider Business Mailing Address
First Line	:	9736 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:	716-688-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	9736 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:	716-688-5717
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JACQUELINE MARIE SZCZUPAKOWSKI
Credential	:	DDS
Telephone Number	:	716-913-4274

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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