Provider Demographics
NPI:1881722973
Name:NEUHAUS, WALTER GORDON (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:GORDON
Last Name:NEUHAUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1839
Mailing Address - Country:US
Mailing Address - Phone:716-774-1235
Mailing Address - Fax:
Practice Address - Street 1:2825 NIAGARA FALLS BLVD
Practice Address - Street 2:STE 170
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2046
Practice Address - Country:US
Practice Address - Phone:716-691-8394
Practice Address - Fax:716-691-8399
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30425OtherLICENSE NUMBER