Provider Demographics
NPI:1942454335
Name:ROBERT J. LACARRUBBA, DDS, PC
Entity Type:Organization
Organization Name:ROBERT J. LACARRUBBA, DDS, PC
Other - Org Name:ELMWOOD VILLAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACARRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-332-2460
Mailing Address - Street 1:892 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1413
Mailing Address - Country:US
Mailing Address - Phone:716-332-2460
Mailing Address - Fax:
Practice Address - Street 1:892 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1413
Practice Address - Country:US
Practice Address - Phone:716-332-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT J. LACARRUBBA, DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046843-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty