Provider Demographics
NPI:1265076459
Name:LYNBROOK LUXURY DENTAL,PC
Entity type:Organization
Organization Name:LYNBROOK LUXURY DENTAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-326-0912
Mailing Address - Street 1:393 SUNRISE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3059
Mailing Address - Country:US
Mailing Address - Phone:516-825-6969
Mailing Address - Fax:516-825-6925
Practice Address - Street 1:393 SUNRISE HWY STE A
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3059
Practice Address - Country:US
Practice Address - Phone:516-825-6969
Practice Address - Fax:516-825-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty