Provider Demographics
NPI:1083199046
Name:JOHN P. EBERZ DDS, PC
Entity Type:Organization
Organization Name:JOHN P. EBERZ DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-674-3737
Mailing Address - Street 1:3811 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3434
Mailing Address - Country:US
Mailing Address - Phone:716-674-3737
Mailing Address - Fax:
Practice Address - Street 1:3811 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3434
Practice Address - Country:US
Practice Address - Phone:716-674-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02808386Medicaid