Provider Demographics
NPI:1073501391
Name:MASSAPEQUA PARK DENTAL PLLC
Entity Type:Organization
Organization Name:MASSAPEQUA PARK DENTAL PLLC
Other - Org Name:DAVID A. LORENZO DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-799-1155
Mailing Address - Street 1:1035 PARK BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2743
Mailing Address - Country:US
Mailing Address - Phone:516-799-1155
Mailing Address - Fax:516-799-4996
Practice Address - Street 1:1035 PARK BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2743
Practice Address - Country:US
Practice Address - Phone:516-799-1155
Practice Address - Fax:516-799-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty