Provider Demographics
NPI:1609930817
Name:KAMINAR, TATYANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:KAMINAR
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 1:506 HAMBURG TPKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2068
Mailing Address - Country:US
Mailing Address - Phone:973-423-1200
Mailing Address - Fax:973-423-1220
Practice Address - Street 1:506 HAMBURG TPKE
Practice Address - Street 2:SUITE 206
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2068
Practice Address - Country:US
Practice Address - Phone:973-423-1200
Practice Address - Fax:973-423-1220
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019378011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0105325Medicaid