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Organization
VICTORIA E. SHACK, DDS, PC
Active
Organization
VICTORIA E. SHACK, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTORIA ELENA SHACK DDS (PRESIDENT)
(631) 928-7500
Entity
Organization
Contact information
Practice address
3 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1597
(631) 928-7500
Mailing address
3 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1597
(631) 928-7500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
056759
NY
Other
Enumeration date
04/15/2016
Last updated
04/15/2016
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