Provider Demographics
NPI:1982465142
Name:DENTIST ON SENECA PLLC
Entity Type:Organization
Organization Name:DENTIST ON SENECA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI-SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-823-2898
Mailing Address - Street 1:2233 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2437
Mailing Address - Country:US
Mailing Address - Phone:716-823-2898
Mailing Address - Fax:716-722-2220
Practice Address - Street 1:2233 SENECA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2437
Practice Address - Country:US
Practice Address - Phone:716-823-2898
Practice Address - Fax:716-722-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental