Provider Demographics
NPI:1396877973
Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WNY PC
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-675-9777
Mailing Address - Street 1:1947 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3339
Mailing Address - Country:US
Mailing Address - Phone:716-675-9777
Mailing Address - Fax:716-675-9645
Practice Address - Street 1:1947 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3339
Practice Address - Country:US
Practice Address - Phone:716-675-9777
Practice Address - Fax:716-675-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY054853Medicare UPIN
NYRA1978Medicare PIN
NYB54853Medicare PIN
NYA54851Medicare PIN
NYU13403Medicare UPIN
NYU02370Medicare UPIN
NY14253CMedicare PIN
NY14253EMedicare PIN
NY14253DMedicare PIN
NYD54851Medicare PIN
NYC54851Medicare PIN
NY05481Medicare UPIN
NYU65486Medicare UPIN
NYT29992Medicare UPIN
NYAA0457Medicare UPIN
NY14253AMedicare UPIN
NYBB9554Medicare UPIN
NYBB9554Medicare PIN