Provider Demographics
NPI:1568811164
Name:LC DENTISTRY PC
Entity Type:Organization
Organization Name:LC DENTISTRY PC
Other - Org Name:DR. BOB'S DENTAL OF CHEEKTOWAGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACARRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-668-2998
Mailing Address - Street 1:3099 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1919
Mailing Address - Country:US
Mailing Address - Phone:716-668-2998
Mailing Address - Fax:716-668-2198
Practice Address - Street 1:3099 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1919
Practice Address - Country:US
Practice Address - Phone:716-668-2998
Practice Address - Fax:716-668-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty