Healthcare Provider Details

I. General information

NPI: 1649259318
Provider Name (Legal Business Name): LINCOLN DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13114 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-2932
US

IV. Provider business mailing address

13114 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-2932
US

V. Phone/Fax

Practice location:
  • Phone: 718-322-9022
  • Fax: 718-322-4220
Mailing address:
  • Phone: 718-322-9022
  • Fax: 718-322-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number046409
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number047347
License Number StateNY

VIII. Authorized Official

Name: DR. MARK LORBER
Title or Position: OWNER
Credential: DDS
Phone: 718-322-9022