| University Pediatric Dentistry, P.c. | |
|
1100 Main Street Buffalo NY 14222 | |
| (716) 242-8200 | |
| Not Available |
| Full Name | University Pediatric Dentistry, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1100 Main Street, Buffalo, New York |
| Authorized Official Name and Position | Roseann Mcanulty (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 7166887712 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Pediatric Dentistry, P.c. 1100 Main St Buffalo NY 14209-2308 Ph: (716) 242-8200 | University Pediatric Dentistry, P.c. 1100 Main Street Buffalo NY 14222 Ph: (716) 242-8200 |
| NPI Number | 1649389560 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 01/13/2012 |
| Medicare PECOS PAC ID | 8628378908 |
|---|---|
| Medicare Enrollment ID | O20151119000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649389560 | NPI | - | NPPES |
| 01181424 | Medicaid | NY | |
| 03376083 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (New York) | Primary |
| Provider Name | Paul Deitrick |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1851527600 PECOS PAC ID: 4284943606 Enrollment ID: I20151026000111 |
| Provider Name | Joli C Chou |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1962548511 PECOS PAC ID: 2567555782 Enrollment ID: I20151026001171 |
| Provider Name | Kelly S Rose |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1932167145 PECOS PAC ID: 8729388855 Enrollment ID: I20151123000311 |
| Provider Name | Thomas B Fallon |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1225293160 PECOS PAC ID: 0749580264 Enrollment ID: I20151204001163 |
| Provider Name | Joseph E Bernat |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1093878845 PECOS PAC ID: 4880994235 Enrollment ID: I20151208000736 |
| Provider Name | Michael L Phillips |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1609997378 PECOS PAC ID: 5799085171 Enrollment ID: I20151208001727 |
| Provider Name | Timothy J Votta |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1841467552 PECOS PAC ID: 5698076826 Enrollment ID: I20151214000804 |
| Provider Name | Carrie A Wanamaker |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1760619480 PECOS PAC ID: 7214238252 Enrollment ID: I20151217000576 |
| Provider Name | Melissa M Fallon |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1003047309 PECOS PAC ID: 8527370683 Enrollment ID: I20151221001851 |
| Provider Name | Margaret A Certo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1669534863 PECOS PAC ID: 0840590022 Enrollment ID: I20151222000297 |
| Provider Name | Hargun K Singh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1477993699 PECOS PAC ID: 0941501456 Enrollment ID: I20151228002045 |
| Provider Name | Kelly A. Burch |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1801206370 PECOS PAC ID: 3274834700 Enrollment ID: I20151229000158 |
| Provider Name | Suketu N Patel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1407985526 PECOS PAC ID: 2668774175 Enrollment ID: I20151230000468 |
| Provider Name | Paul R Creighton |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699895706 PECOS PAC ID: 9931409117 Enrollment ID: I20151230000554 |
| Provider Name | Tammy L Thompson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1265854921 PECOS PAC ID: 1850693078 Enrollment ID: I20160105002393 |
| Provider Name | Amy S Nagai |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1700012655 PECOS PAC ID: 8123320033 Enrollment ID: I20160111000112 |
| Provider Name | Rachel M Anderson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659474229 PECOS PAC ID: 2860797628 Enrollment ID: I20160217000058 |
| Provider Name | Craig A Mcclure |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861517062 PECOS PAC ID: 9032417746 Enrollment ID: I20160413001645 |
| Provider Name | Vineela Redla |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699043422 PECOS PAC ID: 5294023768 Enrollment ID: I20161017000784 |
| Provider Name | Tawfiq N Hazboun |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356658942 PECOS PAC ID: 7618255712 Enrollment ID: I20161025000223 |
| Provider Name | Martesia A Marshall |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043578966 PECOS PAC ID: 4284913252 Enrollment ID: I20161115000457 |
| Provider Name | Michael R Markiewicz |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1225291347 PECOS PAC ID: 6507011152 Enrollment ID: I20170427000112 |
| Provider Name | David C Mccloe |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134514243 PECOS PAC ID: 0547570491 Enrollment ID: I20171109000696 |
Suburban Dentistry Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Abbott Road, Buffalo, NY 14220 Phone: 716-649-5254 Fax: 716-822-0592 | |
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