Basic Information
| Provider Information | |||||||||
| NPI: | 1245423359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | ELIAS | ||||||||
| MiddleName: | JACOB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | SUNY@BUFFALO, DENTAL SCHOOL, 114 SQUIRE HALL | ||||||||
| Address2: | MAIN STREET, SOUTH CAMPUS | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168293717 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SUNY@BUFFALO, DENTAL SCHOOL, 114 SQUIRE HALL | ||||||||
| Address2: | MAIN STREET, SOUTH CAMPUS | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168293717 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 024519 | NY | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.