Provider Demographics
NPI:1942479308
Name:WILLIAMSVILLE FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:WILLIAMSVILLE FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CLAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-568-2273
Mailing Address - Street 1:1630 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3706
Mailing Address - Country:US
Mailing Address - Phone:716-568-2273
Mailing Address - Fax:716-568-2047
Practice Address - Street 1:1630 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3706
Practice Address - Country:US
Practice Address - Phone:716-568-2273
Practice Address - Fax:716-568-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052390-1122300000X
NY053497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02883347Medicaid
NY02783677Medicaid