Provider Demographics
NPI:1831753375
Name:GAROFALO, JANAE NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:NICOLE
Last Name:GAROFALO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 AFFINITY LN APT D
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2424
Mailing Address - Country:US
Mailing Address - Phone:315-409-5862
Mailing Address - Fax:
Practice Address - Street 1:107 AFFINITY LN APT D
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2424
Practice Address - Country:US
Practice Address - Phone:315-409-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY744749659-00Medicaid