Provider Demographics
NPI:1235351982
Name:ALEXANDER PRITSKY, DMD, INC
Entity Type:Organization
Organization Name:ALEXANDER PRITSKY, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT OF THE DENTAL CORPO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-298-3900
Mailing Address - Street 1:7045 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0354
Mailing Address - Country:US
Mailing Address - Phone:559-298-3900
Mailing Address - Fax:559-298-3920
Practice Address - Street 1:7045 N. CHESTNUT AVE. SUITE 102
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-298-3900
Practice Address - Fax:559-298-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52672261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental