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Organization
LAKEVILLE DENTAL GROUP. P.C.
Active
Organization
LAKEVILLE DENTAL GROUP. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH MICHEAL DEVITA D.M.D. (SENIOR PARTNER)
(516) 869-3400
Entity
Organization
Contact information
Practice address
1 HOLLOW LN, SUITE 108, NEW HYDE PARK, NY 11042-1215
(516) 869-3400
(516) 869-3403
Mailing address
1 HOLLOW LN, SUITE 108, NEW HYDE PARK, NY 11042-1215
(516) 869-3400
(516) 869-3403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
031697
NY
Other
Enumeration date
12/30/2008
Last updated
12/30/2008
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