Provider Demographics
NPI:1558987867
Name:EMPIRE DENTAL OF WEBSTER PLLC
Entity Type:Organization
Organization Name:EMPIRE DENTAL OF WEBSTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-671-1650
Mailing Address - Street 1:1674 EMPIRE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1894
Mailing Address - Country:US
Mailing Address - Phone:585-671-1650
Mailing Address - Fax:585-671-4013
Practice Address - Street 1:1674 EMPIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1894
Practice Address - Country:US
Practice Address - Phone:585-671-1650
Practice Address - Fax:585-671-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty