| Richard Etengoff Dds Pc | |
|
1241 Colvin Ave Buffalo NY 14223 | |
| (716) 877-5941 | |
| (716) 877-8409 |
| Full Name | Richard Etengoff Dds Pc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1241 Colvin Ave, Buffalo, New York |
| Authorized Official Name and Position | Richard Alan Etengoff (PRESIDENT ORTHODONTIST) |
| Authorized Official Contact | 7168775941 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Etengoff Dds Pc 1241 Colvin Ave Buffalo NY 14223 Ph: (716) 877-5941 | Richard Etengoff Dds Pc 1241 Colvin Ave Buffalo NY 14223 Ph: (716) 877-5941 |
| NPI Number | 1194911693 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 09/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194911693 | NPI | - | NPPES |
| 00695001 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 0320981 (New York) | Primary |
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