Provider Demographics
NPI:1104953447
Name:PIAZZA, MICHAEL CHARLES (MICHAEL PIAZZA, DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:MICHAEL PIAZZA, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 WENDEL AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2577
Mailing Address - Country:US
Mailing Address - Phone:716-447-0055
Mailing Address - Fax:
Practice Address - Street 1:39 DELAWARE RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2742
Practice Address - Country:US
Practice Address - Phone:716-874-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice