Provider Demographics
NPI:1770975880
Name:GROWING SMILES PEDIATRIC & ADOLESCENT DENTISTRY, PLLC
Entity type:Organization
Organization Name:GROWING SMILES PEDIATRIC & ADOLESCENT DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-580-3580
Mailing Address - Street 1:6501 TRANSIT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1427
Mailing Address - Country:US
Mailing Address - Phone:716-580-3580
Mailing Address - Fax:716-580-3580
Practice Address - Street 1:6501 TRANSIT RD
Practice Address - Street 2:SUITE B
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1427
Practice Address - Country:US
Practice Address - Phone:716-580-3580
Practice Address - Fax:716-580-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0520081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02847652Medicaid