Provider Demographics
NPI:1982850400
Name:TSIMIDIS VUKAS, KALIOPI KELLY (DDS)
Entity Type:Individual
Prefix:
First Name:KALIOPI
Middle Name:KELLY
Last Name:TSIMIDIS VUKAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KALIOPI
Other - Middle Name:KELLY
Other - Last Name:TSIMIDIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4330 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1064
Mailing Address - Country:US
Mailing Address - Phone:716-362-4800
Mailing Address - Fax:
Practice Address - Street 1:9600 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031
Practice Address - Country:US
Practice Address - Phone:716-759-6181
Practice Address - Fax:716-759-6130
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051126-1122300000X
NY0511261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist