Provider Demographics
NPI:1891193140
Name:OKSANA BUBLIK DDS,A DENTAL CORPORATION
Entity Type:Organization
Organization Name:OKSANA BUBLIK DDS,A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUBLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-503-3430
Mailing Address - Street 1:26893 CALLE HERMOSA STE 2
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1635
Mailing Address - Country:US
Mailing Address - Phone:949-503-3430
Mailing Address - Fax:949-380-9507
Practice Address - Street 1:26893 CALLE HERMOSA
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-1635
Practice Address - Country:US
Practice Address - Phone:949-503-3430
Practice Address - Fax:949-503-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639131865OtherNPI TYPE1
CA1891193140Medicaid