NPIMap

Organization Active NPI

Lakewood Family and Cosmetic Dental Care, PC

  • Dentist
  • Lakewood, NJ
National Provider Identifier
1083806582
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI02295200 Issued in NJ
Legal business name
LAKEWOOD FAMILY AND COSMETIC DENTAL CARE, PC
Practice address
500 River Ave
Suite 240
Lakewood, NJ 08701-4738
Phone
(732) 364-5505
Fax
(732) 364-5595
NPI assigned
Aug 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Oleg TabakNPI 1265461420
Title
Dentist
Phone
(732) 364-5505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 22DI02295200 NJ Primary

Addresses

Primary practice location

500 River Ave
Suite 240
Lakewood, NJ 08701-4738

Mailing address

500 River Ave
Suite 240
Lakewood, NJ 08701-4738
Phone (732) 364-5505

National Provider Directory

National Provider Directory

Locations

500 River Ave
Ste 240
Lakewood, NJ 08701
Phone (732) 364-5505

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1083806582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 RIVER AVE",
            "address_2": "SUITE 240",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014738",
            "telephone_number": "732-364-5505",
            "fax_number": "732-364-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 RIVER AVE",
            "address_2": "SUITE 240",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014738",
            "telephone_number": "732-364-5505",
            "fax_number": "732-364-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD FAMILY AND COSMETIC DENTAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2007-08-17",
        "status": "A",
        "authorized_official_last_name": "TABAK",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "732-364-5505",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02295200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.