Provider Demographics
NPI:1427116003
Name:LALOR CREEKSIDE DENTAL
Entity type:Organization
Organization Name:LALOR CREEKSIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-754-2217
Mailing Address - Street 1:2521 VESTAL PKWY W
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1056
Mailing Address - Country:US
Mailing Address - Phone:607-754-2217
Mailing Address - Fax:607-754-0827
Practice Address - Street 1:2521 VESTAL PKWY W
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1056
Practice Address - Country:US
Practice Address - Phone:607-754-2217
Practice Address - Fax:607-754-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty