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

Lake Success Periodontics and Implants PC

Organization Periodontics · NPI 1043417991

Lake Success Periodontics and Implants PC is a Periodontics in New Hyde Park, New York. Licensed in New York. Registered with an NPI since 2007.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1300 Union Tpke Ste 201
New Hyde Park, NY 11040-1759
Phone: (516) 775-3737
Fax: (516) 775-3736
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X · Licence 039925 (NY)

Record details

NPI number1043417991
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Shreck — President · (516) 775-3737
NPI enumeratedJuly 2, 2007
Last updated in NPPESJuly 13, 2016
Mailing address1300 Union Tpke, Suite 201, New Hyde Park, NY 11040-1759

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