South Fork Family Dentistry PC

NPI #1720766868 in East Quogue, New York

Provider Information

NPI Number: 1720766868
Entity Type: Organization
Organization Name: South Fork Family Dentistry PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 10, 2023
Last Updated: Jul 10, 2023

Practice Location

Address: 426 MONTAUK HWY
City: East Quogue
State: New York
ZIP Code: 11942-3952
Phone: (631) 653-4479

Authorized Official

Name: DR. VICTORIA ELENA SHACK, DDS
Title: PRESIDENT
Phone: (917) 324-7927

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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