Provider Demographics
NPI:1316118334
Name:NIAGARA QUALITYCARE DENTISTRY PC
Entity type:Organization
Organization Name:NIAGARA QUALITYCARE DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:8875 PORTER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304
Mailing Address - Country:US
Mailing Address - Phone:716-297-5559
Mailing Address - Fax:716-297-5559
Practice Address - Street 1:8875 PORTER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304
Practice Address - Country:US
Practice Address - Phone:716-297-5559
Practice Address - Fax:716-297-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGRP705113002OtherBC/BS CHILD HEALTH PLUS
NY02824519Medicaid
NYGG332FHP2OtherUNIVERA HEALTHPLEX