Provider Demographics
NPI:1619125002
Name:OUATIK, NABIL (DMD, MSC)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:
Last Name:OUATIK
Suffix:
Gender:M
Credentials:DMD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W SERVICE RD
Mailing Address - Street 2:A238
Mailing Address - City:CHAMPLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:12919-4440
Mailing Address - Country:US
Mailing Address - Phone:514-293-1270
Mailing Address - Fax:
Practice Address - Street 1:3905 61ST ST FL 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3566
Practice Address - Country:US
Practice Address - Phone:718-388-5566
Practice Address - Fax:718-247-5727
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0228421223P0221X
NY0564411223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03544043Medicaid