Organization
RICHARD ETENGOFF DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ALAN ETENGOFF DDS (PRESIDENT ORTHODONTIST)
(716) 877-5941
Entity
Organization
Contact information
Practice address
1241 COLVIN AVE, BUFFALO, NY 14223
(716) 877-5941
(716) 877-8409
Mailing address
1241 COLVIN AVE, BUFFALO, NY 14223
(716) 877-5941
(716) 877-8409
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0320981
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695001
—
NY
Enumeration date
09/18/2007
Last updated
09/18/2007
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