1104057256 NPI number — BETTERSMILE OF W.N.Y., PLLC

Table of content: (NPI 1104057256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104057256 NPI number — BETTERSMILE OF W.N.Y., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTERSMILE OF W.N.Y., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1104057256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6161 TRANSIT RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
EAST AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14051-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-688-3000
Provider Business Mailing Address Fax Number:
716-580-3827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 TRANSIT RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EAST AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14051-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-688-3000
Provider Business Practice Location Address Fax Number:
716-580-3827
Provider Enumeration Date:
08/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIAD
Authorized Official First Name:
SAMER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-688-3000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  050217 , 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)