Provider Demographics
NPI:1619039906
Name:NANCY MUFALLI DDS PC
Entity Type:Organization
Organization Name:NANCY MUFALLI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OFFICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:FORTUNATA
Authorized Official - Last Name:MUFALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-630-1600
Mailing Address - Street 1:5782 MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WMSVL
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-630-1600
Mailing Address - Fax:716-204-3589
Practice Address - Street 1:5782 MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:WMSVL
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-630-1600
Practice Address - Fax:716-204-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04757611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty