Provider Demographics
NPI:1225033657
Name:GORELICK, LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:GORELICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4746
Mailing Address - Country:US
Mailing Address - Phone:845-628-3473
Mailing Address - Fax:845-628-0085
Practice Address - Street 1:530 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4746
Practice Address - Country:US
Practice Address - Phone:845-628-3473
Practice Address - Fax:845-628-0085
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist