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Organization
LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.
Active
Organization
LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SHRECK (PRESIDENT)
(516) 775-3737
Entity
Organization
Contact information
Practice address
1300 UNION TPKE, SUITE 201, NEW HYDE PARK, NY 11040-1759
(516) 775-3737
(516) 775-3736
Mailing address
1300 UNION TPKE, SUITE 201, NEW HYDE PARK, NY 11040-1759
(516) 775-3737
(516) 775-3736
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
039925
NY
Other
Enumeration date
07/02/2007
Last updated
07/13/2016
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