Provider Demographics
NPI:1013078997
Name:DRABIK, STAN D (DDS)
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:D
Last Name:DRABIK
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 1:1110 CROSSPOINTE LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580
Mailing Address - Country:US
Mailing Address - Phone:585-872-4660
Mailing Address - Fax:585-216-1011
Practice Address - Street 1:1110 CROSSPOINTE LANE
Practice Address - Street 2:SUITE B
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:585-872-4660
Practice Address - Fax:585-216-1011
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
7004OtherBCBS
NY02207610Medicaid