Provider Demographics
NPI:1306402193
Name:SHNAYDRUK, ALEX V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:V
Last Name:SHNAYDRUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 MOLNAU CT
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-3221
Mailing Address - Country:US
Mailing Address - Phone:952-261-4307
Mailing Address - Fax:
Practice Address - Street 1:1220 W 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069-9119
Practice Address - Country:US
Practice Address - Phone:320-358-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND142131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice