Provider Demographics
NPI:1215360441
Name:NIAGARA DENTAL IMPLANT & ORAL SURGERY
Entity Type:Organization
Organization Name:NIAGARA DENTAL IMPLANT & ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGALYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:716-282-0285
Mailing Address - Street 1:9650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2004
Mailing Address - Country:US
Mailing Address - Phone:716-759-0707
Mailing Address - Fax:716-759-0709
Practice Address - Street 1:9650 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2004
Practice Address - Country:US
Practice Address - Phone:716-759-0707
Practice Address - Fax:716-759-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty