Provider Demographics
NPI:1265461420
Name:TABAK, OLEG (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:TABAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RIVER AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4738
Mailing Address - Country:US
Mailing Address - Phone:732-364-5505
Mailing Address - Fax:732-364-5595
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:732-364-5505
Practice Address - Fax:732-364-5595
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022952001223G0001X
NY048956-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice