Provider Demographics
NPI:1245420090
Name:VOLUMETRIC CRANIOFACIAL IMAGING CENTERS
Entity type:Organization
Organization Name:VOLUMETRIC CRANIOFACIAL IMAGING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-372-8017
Mailing Address - Street 1:4031 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4507
Mailing Address - Country:US
Mailing Address - Phone:716-646-6900
Mailing Address - Fax:716-312-0036
Practice Address - Street 1:4031 LEGION DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4507
Practice Address - Country:US
Practice Address - Phone:716-646-6900
Practice Address - Fax:716-312-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental