Provider Demographics
NPI:1942315239
Name:HALIK, LYNNE G (DDS)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:G
Last Name:HALIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BRIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2654
Mailing Address - Country:US
Mailing Address - Phone:585-223-5214
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:585-381-2198
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036644-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01631341Medicaid