Provider Demographics
NPI:1578687216
Name:TRI-COUNTY DENTAL, PC
Entity Type:Organization
Organization Name:TRI-COUNTY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-532-4022
Mailing Address - Street 1:104 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1111
Mailing Address - Country:US
Mailing Address - Phone:716-532-4022
Mailing Address - Fax:716-532-2428
Practice Address - Street 1:104 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-532-4022
Practice Address - Fax:716-532-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty