Provider Demographics
NPI:1619039773
Name:WESTERN NEW YORK DENTAL GROUP,PC
Entity Type:Organization
Organization Name:WESTERN NEW YORK DENTAL GROUP,PC
Other - Org Name:DENTAL ASSOCIATES OF ROCHESTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PC ASSISTANT SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-634-4679
Mailing Address - Street 1:1510 RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2405
Mailing Address - Country:US
Mailing Address - Phone:585-865-2200
Mailing Address - Fax:585-865-6693
Practice Address - Street 1:1510 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2405
Practice Address - Country:US
Practice Address - Phone:585-865-2200
Practice Address - Fax:585-865-6693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty