Provider Demographics
NPI:1447338686
Name:COSTER BURGLER, KATHERINE A (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:COSTER BURGLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1413
Mailing Address - Country:US
Mailing Address - Phone:716-332-0460
Mailing Address - Fax:716-881-0460
Practice Address - Street 1:892 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1413
Practice Address - Country:US
Practice Address - Phone:716-332-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02782965Medicaid