Provider Demographics
NPI:1639168768
Name:LYALIN, OLEG (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:LYALIN
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 1:807A UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3410
Mailing Address - Country:US
Mailing Address - Phone:718-922-0237
Mailing Address - Fax:
Practice Address - Street 1:807A UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3410
Practice Address - Country:US
Practice Address - Phone:718-922-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0455611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY105879OtherDORAL
NY01505637Medicaid