Provider Demographics
NPI:1679619225
Name:SVETLAKOV, NATALIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:SVETLAKOV
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 1:705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4722
Mailing Address - Country:US
Mailing Address - Phone:201-342-1362
Mailing Address - Fax:201-342-1372
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4722
Practice Address - Country:US
Practice Address - Phone:201-342-1362
Practice Address - Fax:201-342-1372
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023442001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice