Provider Demographics
NPI:1730751637
Name:QUEEN CITY ENDODONTICS
Entity type:Organization
Organization Name:QUEEN CITY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GENGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-553-3861
Mailing Address - Street 1:111 PARKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3924
Mailing Address - Country:US
Mailing Address - Phone:716-553-3861
Mailing Address - Fax:
Practice Address - Street 1:4001 LEGION DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4507
Practice Address - Country:US
Practice Address - Phone:716-815-3636
Practice Address - Fax:716-815-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty