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LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.

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Company Details

Name: LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 07 Jun 2000 (25 years ago)
Entity Number: 2518390
ZIP code: 11561
County: Nassau
Place of Formation: New York
Principal Address: 1300 UNION TPKE, 201, NEW HYDE PARK, NY, United States, 11040
Address: 1300 UNION TPKE, SUITE 201, NEW HYDE PARK, NY, United States, 11561

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
MICHAEL S SHRECK DMD Chief Executive Officer 1300 UNION TPKE, 201, NEW HYDE PARK, NY, United States, 11040

DOS Process Agent

Name Role Address
LAKE SUCCESS PERIODONTICS AND IMPLANTS P.C. DOS Process Agent 1300 UNION TPKE, SUITE 201, NEW HYDE PARK, NY, United States, 11561

National Provider Identifier

NPI Number:
1043417991

Authorized Person:

Name:
DR. MICHAEL SHRECK
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
1223P0300X - Periodontist
Is Primary:
Yes

Contacts:

Fax:
5167753736

Form 5500 Series

Employer Identification Number (EIN):
113551525
Plan Year:
2023
Number Of Participants:
7
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
4
Sponsors Telephone Number:

History

Start date End date Type Value
2010-06-17 2018-06-04 Address 1300 UNION TPKE, 201, NEW HYDE PARK, NY, 11040, USA (Type of address: Principal Executive Office)
2010-06-17 2018-06-04 Address 1300 UNION TPKE, 201, NEW HYDE PARK, NY, 11040, USA (Type of address: Service of Process)
2002-06-13 2010-06-17 Address 1300 UNION TPKE, 307, NEW HYDE PARK, NY, 11040, USA (Type of address: Chief Executive Officer)
2002-06-13 2010-06-17 Address 1300 UNION TPKE, 307, NEW HYDE PARK, NY, 11040, USA (Type of address: Principal Executive Office)
2002-06-13 2010-06-17 Address 1300 UNION TPKE, 307, NEW HYDE PARK, NY, 11040, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
180604008420 2018-06-04 BIENNIAL STATEMENT 2018-06-01
160602006601 2016-06-02 BIENNIAL STATEMENT 2016-06-01
160211000328 2016-02-11 CERTIFICATE OF AMENDMENT 2016-02-11
151210006122 2015-12-10 BIENNIAL STATEMENT 2014-06-01
120702006032 2012-07-02 BIENNIAL STATEMENT 2012-06-01

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State