1518760925 NPI number — DR. SAMUEL RICHARD CONTI III DMD

Table of content: DR. SAMUEL RICHARD CONTI III DMD (NPI 1518760925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518760925 NPI number — DR. SAMUEL RICHARD CONTI III DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONTI
Provider First Name:
SAMUEL
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DMD
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:
1518760925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3435 MAIN ST
Provider Second Line Business Mailing Address:
119 SQUIRE HALL, FIRST FLOOR
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-899-6637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 MAIN ST
Provider Second Line Business Practice Location Address:
119 SQUIRE HALL, FIRST FLOOR
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-899-6637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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