Provider Demographics
NPI:1780708339
Name:GBUREK BARONE & KUPKA DDS PC
Entity type:Organization
Organization Name:GBUREK BARONE & KUPKA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GBUREK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-786-3676
Mailing Address - Street 1:34 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1017
Mailing Address - Country:US
Mailing Address - Phone:585-786-3676
Mailing Address - Fax:585-786-3896
Practice Address - Street 1:34 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-3676
Practice Address - Fax:585-786-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherFEDERAL TAX ID