Provider Demographics
NPI:1871939157
Name:EMBURY, CAITLIN IRENE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:IRENE
Last Name:EMBURY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:IRENE
Other - Last Name:KRUCZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3860 MCKINLEY PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219
Mailing Address - Country:US
Mailing Address - Phone:716-649-1307
Mailing Address - Fax:
Practice Address - Street 1:3860 MCKINLEY PKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219
Practice Address - Country:US
Practice Address - Phone:716-649-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program