Provider Demographics
NPI:1083924195
Name:VAWNYHS
Entity Type:Organization
Organization Name:VAWNYHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, DENTAL SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITURSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-862-8738
Mailing Address - Street 1:135 PEPPERTREE DR
Mailing Address - Street 2:APT 9
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2919
Mailing Address - Country:US
Mailing Address - Phone:724-456-0855
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-8738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X2865X1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)