Provider Demographics
NPI:1639211915
Name:LGM DENTAL
Entity Type:Organization
Organization Name:LGM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MILHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-423-4000
Mailing Address - Street 1:953 NEW YORK AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1280
Mailing Address - Country:US
Mailing Address - Phone:631-423-4000
Mailing Address - Fax:631-423-1741
Practice Address - Street 1:953 NEW YORK AVE STE 4
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1280
Practice Address - Country:US
Practice Address - Phone:631-423-4000
Practice Address - Fax:631-423-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0346231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00412051Medicaid