| Baker Victory Healthcare Center | |
|
790 Ridge Road Lackawanna NY 14218-1696 | |
| (716) 828-9350 | |
| (716) 828-9355 |
| Full Name | Baker Victory Healthcare Center |
|---|---|
| Speciality | Dentist |
| Location | 790 Ridge Road, Lackawanna, New York |
| Authorized Official Name and Position | Terese M. Scofidio (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7168289515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Baker Victory Healthcare Center 790 Ridge Road Lackawanna NY 14218-1696 Ph: (716) 828-9350 | Baker Victory Healthcare Center 790 Ridge Road Lackawanna NY 14218-1696 Ph: (716) 828-9350 |
| NPI Number | 1619191855 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 10/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619191855 | NPI | - | NPPES |
| 01899518 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1402201R (New York) | Secondary |
| 122300000X | Dentist | (New York) | Primary |
Southtowns Dental Services Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1497 Abbott Road, Lackawanna, NY 14218 Phone: 716-825-5020 Fax: 716-823-7115 |