Lake Success Periodontics and Implants P.C.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

039925 Issued in NY

Legal business name

LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.

Practice address

1300 Union Tpke
Suite 201
New Hyde Park, NY 11040-1759

Phone

(516) 775-3737

Fax

(516) 775-3736

NPI assigned

Jul 2, 2007

Last updated

Jul 13, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael ShreckNPI 1942407895

Title

President

Phone

(516) 775-3737

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Stuart Shreck, D.M.D.

  • Periodontics
  • New Hyde Park, NY
  • NPI 1942407895
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1043417991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 UNION TPKE",
            "address_2": "SUITE 201",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401759",
            "telephone_number": "516-775-3737",
            "fax_number": "516-775-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 UNION TPKE",
            "address_2": "SUITE 201",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401759",
            "telephone_number": "516-775-3737",
            "fax_number": "516-775-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "SHRECK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-775-3737",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "039925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson Lai
• Lake Success Health Medical Wellness PC
• Lake Success Medical Associates
• Lake Success Neurological Surgery PC (Intra-Operative Monitoring Associates)
• Lake Success Ophthalmic Associates PC
• Lake Success Physical Therapy P.C.
• Lake Success RX Corp (Pharmaconic)
• Lake Success Women's Medical Care
• Lakeville Ambulette Transportation LLC
• Lakeville Chiropractic, PC (Chirocare Chiropractic Assoc)

• Periodontics in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.