Provider Demographics
NPI:1720202328
Name:CIRASUNDA-SLAWINOWSKI, DIANE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:A
Last Name:CIRASUNDA-SLAWINOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:A
Other - Last Name:SLAWINOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6480 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-633-6354
Mailing Address - Fax:716-633-7252
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-633-6354
Practice Address - Fax:716-633-7252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049726-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist