1871787259 NPI number — ANDREW L MACDONALD DDS

Table of content: ANDREW L MACDONALD DDS (NPI 1871787259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871787259 NPI number — ANDREW L MACDONALD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
ANDREW
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871787259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1491 SHERIDAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-875-0405
Provider Business Mailing Address Fax Number:
716-875-9620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9650 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARENCE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-759-8323
Provider Business Practice Location Address Fax Number:
716-759-0935
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  042239 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01284826 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com