Provider Demographics
NPI:1346459682
Name:SHKLYAR, ALEX (DDS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:SHKLYAR
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 1:7525 GREENWAY CENTER DR.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:22151-3915
Mailing Address - Country:US
Mailing Address - Phone:301-345-2880
Mailing Address - Fax:301-345-6287
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE #102
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-345-2880
Practice Address - Fax:301-345-6287
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist