Provider Demographics
NPI:1679623755
Name:BARAK, ANATOLIY (DMD)
Entity type:Individual
Prefix:DR
First Name:ANATOLIY
Middle Name:
Last Name:BARAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 NEPTUNE AVE
Mailing Address - Street 2:APT. 5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4065
Mailing Address - Country:US
Mailing Address - Phone:718-872-5418
Mailing Address - Fax:
Practice Address - Street 1:66-26 METROPOLITAN AVE.
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:718-821-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist