Provider Demographics
NPI:1750494050
Name:ORTHODONTISTS ASSOCIATES OF WESTERN NEW YORK, PC
Entity Type:Organization
Organization Name:ORTHODONTISTS ASSOCIATES OF WESTERN NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-372-8017
Mailing Address - Street 1:138 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2504
Mailing Address - Country:US
Mailing Address - Phone:716-372-8017
Mailing Address - Fax:
Practice Address - Street 1:138 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2504
Practice Address - Country:US
Practice Address - Phone:716-372-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0415501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty