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GREEN LAKES DENTAL, LLP
NPI 1174259212
Clinic/Center - Dental in Fayetteville, NY

Active since July 30, 2022
511 E GENESEE ST, FAYETTEVILLE, NY 13066(315) 637-4616 Get Directions Write a Review

NPPES record last updated: July 30, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Green Lakes Dental, Llp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREEN LAKES DENTAL, LLP (NPI 1174259212) is a healthcare organization registered as a dental in Fayetteville, New York and active in the NPI registry since July 2022. The organization lists Tyler Maxwell, Owner, as its authorized official.

NPPES Registry Identity

NPI1174259212
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameGREEN LAKES DENTAL, LLP
Location Address511 E GENESEE STFayetteville, NY 13066-1524
Mailing Address511 E Genesee StFayetteville, NY 13066-1524 · (585) 469-8545
Phone(315) 637-4616
Organization SubpartNo
Authorized OfficialTyler MaxwellOwner · (315) 637-4616
Enumeration DateJuly 30, 2022
NPPES CertifiedJuly 30, 2022
✔ NPI 1174259212 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
511 E GENESEE ST, Fayetteville, NY 13066
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Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELISSA TRAINO LMT
Massage Therapist
511 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 372-2307
TYLER J MAXWELL
Dentist (General Practice)
511 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 637-4616
MINDBODY CONNECTION MASSAGE & FITNESS
Clinic/Center
511 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 372-2307
JULIE L RIEDL INC
Durable Medical Equipment & Medical Supplies (Dialysis Equipment & Supplies)
511 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 637-2307

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Green Lakes Dental, LLP's NPI number?

The NPI number for Green Lakes Dental, LLP is 1174259212. It was assigned to this organization in the NPPES registry on July 30, 2022.

Where is Green Lakes Dental, LLP located?

Green Lakes Dental, LLP is located at 511 E Genesee St, Fayetteville, NY 13066. The listed phone number is (315) 637-4616.

What is Green Lakes Dental, LLP's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Green Lakes Dental, LLP was last updated on July 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.