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Organization
SOUTH FORK FAMILY DENTISTRY PC
Active
Organization
SOUTH FORK FAMILY DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTORIA ELENA SHACK DDS (PRESIDENT)
(917) 324-7927
Entity
Organization
Contact information
Practice address
426 MONTAUK HWY, EAST QUOGUE, NY 11942-3952
(631) 653-4479
Mailing address
4 SCHEYER CT, MEDFORD, NY 11763-3022
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/10/2023
Last updated
07/10/2023
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