Provider Demographics
NPI:1457648503
Name:NORTH BUFFALO DENTAL
Entity Type:Organization
Organization Name:NORTH BUFFALO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-803-1600
Mailing Address - Street 1:1600 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2904
Mailing Address - Country:US
Mailing Address - Phone:716-803-1600
Mailing Address - Fax:716-875-5414
Practice Address - Street 1:1600 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2904
Practice Address - Country:US
Practice Address - Phone:716-803-1600
Practice Address - Fax:716-875-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty