1871939157 NPI number — DR. CAITLIN IRENE EMBURY D.D.S.

Table of content: DR. CAITLIN IRENE EMBURY D.D.S. (NPI 1871939157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871939157 NPI number — DR. CAITLIN IRENE EMBURY D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMBURY
Provider First Name:
CAITLIN
Provider Middle Name:
IRENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRUCZEK
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871939157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3860 MCKINLEY PARKWAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BLASDELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-649-1307
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3860 MCKINLEY PKWAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BLASDELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-649-1307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2013

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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