MEDICARE: CHARLES ALAN MATLACH

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	122300000X	Dentist	NY 32221	NY

General Provider Information

NPI Number	:	1306859483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ALAN MATLACH

Provider Business Mailing Address
First Line	:	5281 VIA DEL SOLE
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221
Country	:	US
Telephone Number	:	716-636-8215
Fax Number	:	716-688-2984

Provider Business Practice Location Address
First Line	:	8397 BOSTON STATE RD
Second Line	:
City	:	BOSTON
State	:	NY
Zip	:	14025-9651
Country	:	US
Telephone Number	:	716-941-5433
Fax Number	:	716-941-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	11/01/2010

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Directions to “ CHARLES ALAN MATLACH ” Practice Location

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