Organization
LAKE GROVE DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEENA SHAH (OWNER)
(631) 467-7878
Entity
Organization
Contact information
Practice address
1014 HAWKINS AVE, LAKE GROVE, NY 11755-1600
(631) 467-7878
Mailing address
1014 HAWKINS AVE, LAKE GROVE, NY 11755-1600
(631) 467-7878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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