Provider Demographics
NPI:1588962971
Name:LONG ISLAND FAMILY DENTISTRY
Entity type:Organization
Organization Name:LONG ISLAND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-835-0569
Mailing Address - Street 1:6 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1810
Mailing Address - Country:US
Mailing Address - Phone:631-835-9569
Mailing Address - Fax:
Practice Address - Street 1:26 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3827
Practice Address - Country:US
Practice Address - Phone:631-835-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0540161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty