MEDICARE: DR. MICHAEL BOYCZUK D.D.S.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	044040-2	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010297701	OTHER	NY	UNIVERA HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821024670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BOYCZUK D.D.S.

Provider Business Mailing Address
First Line	:	1947 RIDGE RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3339
Country	:	US
Telephone Number	:	716-675-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1947 RIDGE RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3339
Country	:	US
Telephone Number	:	716-675-9777
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/14/2007

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