Provider Demographics
NPI:1982435558
Name:WESTERN NEW YORK ENDODONTICS
Entity type:Organization
Organization Name:WESTERN NEW YORK ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELTAGOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MDS
Authorized Official - Phone:716-630-9999
Mailing Address - Street 1:8201 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6046
Mailing Address - Country:US
Mailing Address - Phone:716-630-9999
Mailing Address - Fax:
Practice Address - Street 1:8201 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6046
Practice Address - Country:US
Practice Address - Phone:716-630-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty