Provider Demographics
NPI:1356093744
Name:ADVANCED DENTAL OF WNY
Entity Type:Organization
Organization Name:ADVANCED DENTAL OF WNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACARRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-297-1711
Mailing Address - Street 1:9501 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4910
Mailing Address - Country:US
Mailing Address - Phone:716-297-1711
Mailing Address - Fax:
Practice Address - Street 1:9501 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4910
Practice Address - Country:US
Practice Address - Phone:716-297-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental