Provider Demographics
NPI:1477741635
Name:PEDIATRIC DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-633-1991
Mailing Address - Street 1:13 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4641
Mailing Address - Country:US
Mailing Address - Phone:716-633-1991
Mailing Address - Fax:716-633-2435
Practice Address - Street 1:13 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4641
Practice Address - Country:US
Practice Address - Phone:716-633-1991
Practice Address - Fax:716-633-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0369381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty