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Green Lakes Dental, LLP

Dental Clinic/Center in Fayetteville, NY · enumerated 2022 · authorized official Tyler Maxwell, Owner.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1174259212

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Registry record

Entity type Organization (Type 2)
Legal business name Green Lakes Dental, LLP
Practice address 511 E Genesee St, Fayetteville, NY, 13066
Phone (315) 637-4616
Enumeration date Jul 30, 2022
Last updated in NPPES Jul 30, 2022

Taxonomy & classification

261QD0000X Dental Clinic/Center Ambulatory Health Care Facilities Primary

Authorized official

Name Tyler Maxwell
Title Owner
Phone (315) 637-4616

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is Green Lakes Dental, LLP located?
The practice location on file with NPPES is in Fayetteville, NY.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2022-07-30. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2022-07-30.