Provider Demographics
NPI:1790260982
Name:ORCHARD PARK DENTALCARE PLLC
Entity Type:Organization
Organization Name:ORCHARD PARK DENTALCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMCHANDRAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-820-9291
Mailing Address - Street 1:25 PRESTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1648
Mailing Address - Country:US
Mailing Address - Phone:617-820-9291
Mailing Address - Fax:
Practice Address - Street 1:3302 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-222-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty