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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