MEDICARE: OKSANA BUBLIK DDS,A DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639131865	OTHER	CA	NPI TYPE1
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891193140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKSANA BUBLIK DDS,A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	26893 CALLE HERMOSA STE 2
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92624-1635
Country	:	US
Telephone Number	:	949-503-3430
Fax Number	:	949-380-9507

Provider Business Practice Location Address
First Line	:	26893 CALLE HERMOSA
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92624-1635
Country	:	US
Telephone Number	:	949-503-3430
Fax Number	:	949-503-3431

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OKSANA V BUBLIK
Credential	:	DDS
Telephone Number	:	949-503-3430

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	09/19/2022

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