Basic Information
| Provider Information | |||||||||
| NPI: | 1972730695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LURIA | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 DELAWARE AVE APT 7B | ||||||||
| Address2: | 3435 MAIN STREET | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142092414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347308664 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 112 SQUIRE HALL | ||||||||
| Address2: | 3435 MAIN ST | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142148006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168292722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2009 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204E00000X | 019-030536 | IL | Y | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 1223S0112X | P69996 | NY | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.