Provider Demographics
NPI:1639470701
Name:MARIO J. VIOLANTE DDS PLLC
Entity Type:Organization
Organization Name:MARIO J. VIOLANTE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VIOLANTE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-297-6453
Mailing Address - Street 1:1 COLOMBA DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1205
Mailing Address - Country:US
Mailing Address - Phone:716-297-6453
Mailing Address - Fax:716-297-6487
Practice Address - Street 1:1 COLOMBA DR
Practice Address - Street 2:SUITE #6
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1205
Practice Address - Country:US
Practice Address - Phone:716-297-6453
Practice Address - Fax:716-297-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048498261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1194868836Medicaid