| Victoria E. Shack, Dds, Pc | |
|
3 Medical Dr Suite D Port Jefferson Station NY 11776-1597 | |
| (631) 928-7500 | |
| Not Available |
| Full Name | Victoria E. Shack, Dds, Pc |
|---|---|
| Speciality | Dentist |
| Location | 3 Medical Dr, Port Jefferson Station, New York |
| Authorized Official Name and Position | Victoria Elena Shack (PRESIDENT) |
| Authorized Official Contact | 6319287500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victoria E. Shack, Dds, Pc 3 Medical Dr Suite D Port Jefferson Station NY 11776-1597 Ph: (631) 928-7500 | Victoria E. Shack, Dds, Pc 3 Medical Dr Suite D Port Jefferson Station NY 11776-1597 Ph: (631) 928-7500 |
| NPI Number | 1366896466 |
|---|---|
| Provider Enumeration Date | 04/15/2016 |
| Last Update Date | 04/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366896466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 056759 (New York) | Primary |
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