Green Lakes Dental, LLP
NPI #1174259212 in Fayetteville, New York
Provider Information
- NPI Number
- 1174259212
- Entity Type
- Organization
- Organization Name
- Green Lakes Dental, LLP
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jul 30, 2022
- Last Updated
- Jul 30, 2022
Practice Location
- Address
- 511 E GENESEE ST
- City
- Fayetteville
- State
- New York
- ZIP Code
- 13066-1524
- Phone
- (315) 637-4616
Authorized Official
- Name
- DR. TYLER MAXWELL
- Title
- OWNER
- Phone
- (315) 637-4616
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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