Provider Demographics
NPI:1275640732
Name:BUFFA, PHILIP VINCENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:VINCENT
Last Name:BUFFA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3349
Mailing Address - Country:US
Mailing Address - Phone:516-489-3844
Mailing Address - Fax:
Practice Address - Street 1:486 DOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3349
Practice Address - Country:US
Practice Address - Phone:516-489-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice