South Fork Family Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH FORK FAMILY DENTISTRY PC

Practice address

426 Montauk Hwy
East Quogue, NY 11942-3952

Phone

(631) 653-4479

NPI assigned

Jul 10, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Victoria Elena Shack, DDSNPI 1538427802

Title

President

Phone

(917) 324-7927

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victoria Elena Shack, DDS

  • General Practice Dentistry
  • Rocky Point, NY
  • NPI 1538427802

  General Practice

  NPD Authorized official
• John J Romano, D.D.S.

  • General Practice Dentistry
  • East Quogue, NY
  • NPI 1124184684

  General Practice

  NPD (past)

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1720766868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SCHEYER CT",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 MONTAUK HWY",
            "city": "EAST QUOGUE",
            "state": "NY",
            "postal_code": "119423952",
            "telephone_number": "631-653-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FORK FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-09",
        "status": "A",
        "authorized_official_last_name": "SHACK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "ELENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-324-7927",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Russo
• Greta Sataite, LAC.
• Farrand Elizabeth Seltenreich, CCC-SLP
• Seth Greiner PT PLLC
• Renee C Smith, RN
• Richard John Spano, R. N.
• Elli Vamvakitis
• Christine M Woods, NP

• All providers in East Quogue, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.