Provider Demographics
NPI:1689908378
Name:STEVEN L. LYSENKO, DMD PLLC
Entity Type:Organization
Organization Name:STEVEN L. LYSENKO, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:578-765-4616
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:17 MAPLE ROAD
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186
Mailing Address - Country:US
Mailing Address - Phone:518-765-4616
Mailing Address - Fax:518-765-9348
Practice Address - Street 1:17 MAPLE ROAD
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186
Practice Address - Country:US
Practice Address - Phone:518-765-4616
Practice Address - Fax:518-765-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty