Provider Demographics
NPI:1154307171
Name:DULAK, OLINA M (DDS)
Entity Type:Individual
Prefix:
First Name:OLINA
Middle Name:M
Last Name:DULAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CENTRAL AVE
Mailing Address - Street 2:PO BOX 65
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136
Mailing Address - Country:US
Mailing Address - Phone:716-934-0600
Mailing Address - Fax:
Practice Address - Street 1:195 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136
Practice Address - Country:US
Practice Address - Phone:716-934-0600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000754217002OtherBLUE CROSS BLUE SHIELD
NY01708938Medicaid