Provider Demographics
NPI:1578290755
Name:TATARSKY, BIANA CHANNEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BIANA
Middle Name:CHANNEL
Last Name:TATARSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BIANA
Other - Middle Name:CHANNEL
Other - Last Name:GOTLIBOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1170 SEAWANE DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1170 SEAWANE DR
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2649
Practice Address - Country:US
Practice Address - Phone:718-781-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0625661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics