Provider Demographics
NPI:1720257512
Name:ROBERT J LACARRUBBA
Entity Type:Organization
Organization Name:ROBERT J LACARRUBBA
Other - Org Name:ROBERT J LACARRUBBA DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACARRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-631-2728
Mailing Address - Street 1:4927 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-631-2728
Mailing Address - Fax:716-631-5824
Practice Address - Street 1:4927 MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-631-2728
Practice Address - Fax:716-631-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA1941OtherHEALTH PLEX
NY01751248Medicaid
NY4091831OtherINDEPENDANT HEALTH ASSOC
NY0012598OtherFIDELIS