Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Green Lakes Dental, LLP

Organization Dental Clinic/Center · NPI 1174259212

Green Lakes Dental, LLP is a Dental Clinic/Center in Fayetteville, New York. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
LLP — Limited liability partnership
A form of business registration, not a clinical qualification.

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Practice location Address checks out

511 E Genesee St
Fayetteville, NY 13066-1524
Phone: (315) 637-4616
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1174259212
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tyler Maxwell — Owner · (315) 637-4616
NPI enumeratedJuly 30, 2022
Last updated in NPPESJuly 30, 2022
Certification dateJuly 30, 2022
Mailing address511 E Genesee St, Fayetteville, NY 13066-1524

Other providers in Fayetteville