Provider Demographics
NPI:1821308727
Name:BEMUS POINT DENTAL, LLC
Entity Type:Organization
Organization Name:BEMUS POINT DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-763-9711
Mailing Address - Street 1:9 MERZ AVE
Mailing Address - Street 2:
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712
Mailing Address - Country:US
Mailing Address - Phone:716-386-5295
Mailing Address - Fax:
Practice Address - Street 1:9 MERZ AVE
Practice Address - Street 2:
Practice Address - City:BEMUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14712
Practice Address - Country:US
Practice Address - Phone:716-386-5295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty