MEDICARE: DR. OLEG LYALIN DDS

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	1223G0001X	General Practice Dentistry	045561	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105879	OTHER	NY	DORAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639168768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLEG LYALIN DDS

Provider Business Mailing Address
First Line	:	807A UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3410
Country	:	US
Telephone Number	:	718-922-0237
Fax Number	:

Provider Business Practice Location Address
First Line	:	807A UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3410
Country	:	US
Telephone Number	:	718-922-0237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/13/2009

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