Provider Demographics
NPI:1841654571
Name:APPLEGATE DENTAL
Entity type:Organization
Organization Name:APPLEGATE DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAINBROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-689-8882
Mailing Address - Street 1:777 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2320
Mailing Address - Country:US
Mailing Address - Phone:716-689-8882
Mailing Address - Fax:716-689-6183
Practice Address - Street 1:777 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2320
Practice Address - Country:US
Practice Address - Phone:716-689-8882
Practice Address - Fax:716-689-6183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLEGATE DENTAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty