Provider Demographics
NPI:1275193039
Name:ALEKSANDRYANTS, GABRIEL (DMD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:ALEKSANDRYANTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GAIL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2212
Mailing Address - Country:US
Mailing Address - Phone:718-938-5639
Mailing Address - Fax:
Practice Address - Street 1:223 MALLORY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1256
Practice Address - Country:US
Practice Address - Phone:718-938-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027591001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice