Provider Demographics
NPI:1699090928
Name:QUIGLEY, MICHAEL B (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9692
Mailing Address - Country:US
Mailing Address - Phone:315-637-6961
Mailing Address - Fax:
Practice Address - Street 1:920 AMHERST ST
Practice Address - Street 2:APT # 4
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3546
Practice Address - Country:US
Practice Address - Phone:716-207-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055466-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry