Provider Demographics
NPI:1063852432
Name:TAPIA, JOSE LUIS (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JOSE LUIS
Middle Name:
Last Name:TAPIA
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:355 SQUIRE HALL, UNIVERSITY AT BUFFALO
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-2538
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:355 SQUIRE HALL, UNIVERSITY AT BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056546-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology