Provider Demographics
NPI:1538691803
Name:NEW ERA DENTAL, PLLC
Entity type:Organization
Organization Name:NEW ERA DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MEGNA-ACORLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-249-4999
Mailing Address - Street 1:2746 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1702
Mailing Address - Country:US
Mailing Address - Phone:716-249-4999
Mailing Address - Fax:
Practice Address - Street 1:2746 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1702
Practice Address - Country:US
Practice Address - Phone:716-249-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055802122300000X
NY056299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty