Provider Demographics
NPI:1154511616
Name:ALEXANDER BORISOVICH CHUKREEFF, D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALEXANDER BORISOVICH CHUKREEFF, D.D.S., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKREEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-563-8123
Mailing Address - Street 1:1806 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4308
Mailing Address - Country:US
Mailing Address - Phone:415-563-8123
Mailing Address - Fax:
Practice Address - Street 1:1806 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4308
Practice Address - Country:US
Practice Address - Phone:415-563-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty