Provider Demographics
NPI:1821007691
Name:WNY TMD & OROFACIAL PAIN
Entity Type:Organization
Organization Name:WNY TMD & OROFACIAL PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KULL
Authorized Official - Suffix:
Authorized Official - Credentials:D D S M S
Authorized Official - Phone:716-675-5858
Mailing Address - Street 1:4134 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3044
Mailing Address - Country:US
Mailing Address - Phone:716-675-5858
Mailing Address - Fax:716-675-4872
Practice Address - Street 1:4134 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3044
Practice Address - Country:US
Practice Address - Phone:716-675-5858
Practice Address - Fax:716-675-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285171744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4001292OtherINDEPENDENT HEALTH INS
NY013601Medicare ID - Type UnspecifiedMEDICAL CARE FOR TMJ