Provider Demographics
NPI:1497905509
Name:PETER A ROUFF DMD PLLC
Entity Type:Organization
Organization Name:PETER A ROUFF DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:716-693-9077
Mailing Address - Street 1:495 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5348
Mailing Address - Country:US
Mailing Address - Phone:716-693-9077
Mailing Address - Fax:716-693-9243
Practice Address - Street 1:495 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5348
Practice Address - Country:US
Practice Address - Phone:716-693-9077
Practice Address - Fax:716-693-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0524051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty