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Organization

ELMWOOD VILLAGE DENTAL PC

Active
Other names
DR. BOB'S DENTAL CARE
Organization subpart
No

Provider details

NPI number
Authorized official
DEBORAH DAMICO (CREDENTIALING LIAISON)
(716) 646-9423
Entity
Organization

Contact information

Practice address
892 ELMWOOD AVE, BUFFALO, NY 14222-1494
(716) 332-0460
(716) 881-0449
Mailing address
2707 SHERIDAN DR, TONAWANDA, NY 14150-9466
(716) 646-9423
(716) 557-7225

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1124581251
INDIVIDUAL NPI
NY
01
1154781326
INDIVIDUAL NPI
NY
01
1235378803
INDIVIDUAL NPI
NY
01
1295767598
INDIVIDUAL NPI
NY
01
1356918080
INDIVIDUAL NPI
NY
01
1417334293
INDIVIDUAL NPI
NY
01
1447338686
INDIVIDUAL NPI
NY
01
1467915165
INDIVIDUAL NPI
NY
01
1720471063
INDIVIDUAL NPI
NY
01
1831727882
INDIVIDUAL NPI
NY
01
1942677539
INDIVIDUAL NPI
NY
Enumeration date
01/03/2022
Last updated
01/03/2022
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