MEDICARE: RICHARD OHRBACH PHD, DDS

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	103TC0700X	Clinical Psychologist	013564-1	NY
2	122300000X	Dentist	045850-1	NY
3	1223X2210X	Orofacial Pain Dentistry	45850-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000525127007	OTHER	NY	BLUE CROSS
2	000525127006	OTHER	NY	BLUE CROSS-COMMUNITY BLUE
3	4001468	OTHER	NY	IHA

General Provider Information

NPI Number	:	1891846515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD OHRBACH PHD, DDS

Provider Business Mailing Address
First Line	:	3435 MAIN ST
Second Line	:	355 SQUIRE HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-3590
Fax Number	:	716-829-3554

Provider Business Practice Location Address
First Line	:	3435 MAIN ST
Second Line	:	355 SQUIRE HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-3590
Fax Number	:	716-829-3554

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	10/09/2019

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