Provider Demographics
NPI:1376732693
Name:MICHAEL LAZAR DDS DANIEL F COYLE DDS PETER L AKL DDS PC
Entity Type:Organization
Organization Name:MICHAEL LAZAR DDS DANIEL F COYLE DDS PETER L AKL DDS PC
Other - Org Name:EDWARD BERG DDS MICHAEL LAZAR DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-921-0222
Mailing Address - Street 1:800 WOODBURY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-921-0222
Mailing Address - Fax:516-921-0937
Practice Address - Street 1:800 WOODBURY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-921-0222
Practice Address - Fax:516-921-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0377351223G0001X
NY0389021223G0001X
NY0447781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty