Provider Demographics
NPI:1366587214
Name:WEST, EUGENE (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:ENDODONTIC
Other - Middle Name:SPECIALISTS
Other - Last Name:PC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4820 W TAFT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2800
Mailing Address - Country:US
Mailing Address - Phone:315-413-1100
Mailing Address - Fax:315-413-0710
Practice Address - Street 1:4820 W TAFT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2800
Practice Address - Country:US
Practice Address - Phone:315-413-1100
Practice Address - Fax:315-413-0710
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0472891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics