Provider Demographics
NPI:1316060270
Name:GORELIK, TATYANA (DDS)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:GORELIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2213
Mailing Address - Country:US
Mailing Address - Phone:610-363-2530
Mailing Address - Fax:610-363-7705
Practice Address - Street 1:234 N POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2213
Practice Address - Country:US
Practice Address - Phone:610-363-2530
Practice Address - Fax:610-363-7705
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031001L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist