MEDICARE: DR. LAWRENCE IRA SENZER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	038711	NY

General Provider Information

NPI Number	:	1588797500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE IRA SENZER D.D.S.

Provider Business Mailing Address
First Line	:	727 N BROADWAY
Second Line	:	SUITE B-3
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-795-2791
Fax Number	:	516-798-8164

Provider Business Practice Location Address
First Line	:	727 N BROADWAY
Second Line	:	SUITE B-3
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-795-2791
Fax Number	:	516-798-8164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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