Provider Demographics
NPI:1588858344
Name:CEPELAK, LAWRENCE JOSEPH JR (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:CEPELAK
Suffix:JR
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 1:11 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4152
Mailing Address - Country:US
Mailing Address - Phone:631-588-1742
Mailing Address - Fax:
Practice Address - Street 1:11 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4152
Practice Address - Country:US
Practice Address - Phone:631-588-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01945202Medicaid