Provider Demographics
NPI:1669651493
Name:ROUFF, PETER A (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:ROUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:716-693-9077
Mailing Address - Fax:716-693-9243
Practice Address - Street 1:495 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-693-9077
Practice Address - Fax:716-693-9243
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052405-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics