Provider Demographics
NPI:1659360725
Name:RYBAK, MARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:RYBAK
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 1:539 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3786
Mailing Address - Country:US
Mailing Address - Phone:215-355-7790
Mailing Address - Fax:215-355-6637
Practice Address - Street 1:539 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3786
Practice Address - Country:US
Practice Address - Phone:215-355-7790
Practice Address - Fax:215-355-6637
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030223L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014404OtherHEALTH PARTNERS
PA0018668890001OtherMEDICAL ASSISTANCE