Provider Demographics
NPI:1205368495
Name:KRISKO, ALEXANDER JOHN (DMD, MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOHN
Last Name:KRISKO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2526
Mailing Address - Country:US
Mailing Address - Phone:828-322-1667
Mailing Address - Fax:828-324-5877
Practice Address - Street 1:3452 GRAYSTONE PL SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8200
Practice Address - Country:US
Practice Address - Phone:828-322-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99621223S0112X
NC126931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery