Provider Demographics
NPI:1396186912
Name:SYEDLOC DENTISTRY,PC
Entity Type:Organization
Organization Name:SYEDLOC DENTISTRY,PC
Other - Org Name:DR. BOB'S DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LACARRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-833-2727
Mailing Address - Street 1:2727 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1701
Mailing Address - Country:US
Mailing Address - Phone:716-833-2727
Mailing Address - Fax:716-833-2729
Practice Address - Street 1:2727 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1701
Practice Address - Country:US
Practice Address - Phone:716-833-2727
Practice Address - Fax:716-833-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028874-11223G0001X
NY045205-11223G0001X
NY055539-11223G0001X
NY0468431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty