Provider Demographics
NPI:1891846515
Name:OHRBACH, RICHARD (PHD, DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:OHRBACH
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:355 SQUIRE HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-3590
Mailing Address - Fax:716-829-3554
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:355 SQUIRE HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-3590
Practice Address - Fax:716-829-3554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013564-1103TC0700X
NY045850-1122300000X
NY45850-11223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525127007OtherBLUE CROSS
NY000525127006OtherBLUE CROSS-COMMUNITY BLUE
NY4001468OtherIHA
NY13022IMedicare UPIN