Provider Demographics
NPI:1255406526
Name:WESTERN NEW YORK DENTAL GROUP, PC
Entity type:Organization
Organization Name:WESTERN NEW YORK DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:EHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-824-5857
Mailing Address - Street 1:125 LAWRENCE BELL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7817
Mailing Address - Country:US
Mailing Address - Phone:716-634-4679
Mailing Address - Fax:716-634-5415
Practice Address - Street 1:800 HARLEM RD
Practice Address - Street 2:SUITE 400
Practice Address - City:W SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1083
Practice Address - Country:US
Practice Address - Phone:716-824-5857
Practice Address - Fax:716-824-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty