Individual
LORETA GENEVICIUTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
714 MAIN ST, PORT JEFFERSON, NY 11777-2223
(631) 473-0582
Mailing address
415 E 37TH ST APT 36K, NEW YORK, NY 10016-0139
(929) 284-9277
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
059543
NY
Other
Enumeration date
12/22/2017
Last updated
12/22/2017
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