MEDICARE: SHAY MARKOVITCH DENTISTRY, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	1223E0200X	Endodontics
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1609627124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAY MARKOVITCH DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	3513 THOMAS DR STE 8
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480-9759
Country	:	US
Telephone Number	:	585-346-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3513 THOMAS DR STE 8
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480-9759
Country	:	US
Telephone Number	:	585-346-5220
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	ELIZABETH WORTHMAN
Credential	:
Telephone Number	:	845-842-9221

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	10/21/2025

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