Provider Demographics
NPI:1497775290
Name:PUDLEWSKI, DIANE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:P
Last Name:PUDLEWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:125 LAWRENCE BELL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7817
Mailing Address - Country:US
Mailing Address - Phone:716-634-4679
Mailing Address - Fax:716-634-5415
Practice Address - Street 1:9 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9509
Practice Address - Country:US
Practice Address - Phone:716-537-2211
Practice Address - Fax:716-537-2575
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0467271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice