Provider Demographics
NPI:1164671392
Name:NASHTATIK, OLEG (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:NASHTATIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4505
Mailing Address - Country:US
Mailing Address - Phone:718-692-3333
Mailing Address - Fax:718-377-0060
Practice Address - Street 1:2006 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4505
Practice Address - Country:US
Practice Address - Phone:718-692-3333
Practice Address - Fax:718-377-0060
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040085-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice