Provider Demographics
NPI:1891112207
Name:LYNNE G. HALIK DDS
Entity Type:Organization
Organization Name:LYNNE G. HALIK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-381-2190
Mailing Address - Street 1:145 SULLYS TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4561
Mailing Address - Country:US
Mailing Address - Phone:585-381-2190
Mailing Address - Fax:
Practice Address - Street 1:145 SULLYS TRL
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4561
Practice Address - Country:US
Practice Address - Phone:585-381-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03664411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942315239Medicaid