1922264282 NPI number — ALEKSANDR V LUTSKIY DMD

Table of content: ALEKSANDR V LUTSKIY DMD (NPI 1922264282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922264282 NPI number — ALEKSANDR V LUTSKIY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTSKIY
Provider First Name:
ALEKSANDR
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUTSKIY
Provider Other First Name:
ALEKSANDR
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922264282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 E WESLEY AVE
Provider Second Line Business Mailing Address:
4
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-6050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-758-3230
Provider Business Mailing Address Fax Number:
303-758-3552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 E WESLEY AVE
Provider Second Line Business Practice Location Address:
4
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-758-3230
Provider Business Practice Location Address Fax Number:
303-758-3552
Provider Enumeration Date:
08/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  9755 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)