MEDICARE: DR IRWIN L BURSTEIN DDS PC

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	1223P0300X	Periodontics	22706	NY

General Provider Information

NPI Number	:	1649286303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR IRWIN L BURSTEIN DDS PC

Provider Business Mailing Address
First Line	:	1060 COLVIN AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1905
Country	:	US
Telephone Number	:	716-873-7030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 COLVIN AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1905
Country	:	US
Telephone Number	:	716-873-7030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRWIN L BURSTEIN
Credential	:	DDS
Telephone Number	:	716-873-7030

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2020

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