Provider Demographics
NPI:1366968976
Name:LIF DENTAL BUFFALO PLLC
Entity type:Organization
Organization Name:LIF DENTAL BUFFALO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HURON
Authorized Official - Middle Name:O
Authorized Official - Last Name:HILL
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-838-3838
Mailing Address - Street 1:235 AERO DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1429
Mailing Address - Country:US
Mailing Address - Phone:716-838-3838
Mailing Address - Fax:716-839-8004
Practice Address - Street 1:2000 EGGERT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2139
Practice Address - Country:US
Practice Address - Phone:716-838-3838
Practice Address - Fax:716-838-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058433261QD0000X
NY043499261QD0000X
NY044659261QD0000X
NY057325261QD0000X
NY035833261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental