Provider Demographics
NPI:1467756627
Name:ORESKOVICH, ANTHONY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:ORESKOVICH
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 1:1111 PUEBLO BOULEVARD WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1687
Mailing Address - Country:US
Mailing Address - Phone:719-542-8182
Mailing Address - Fax:719-545-1585
Practice Address - Street 1:1111 PUEBLO BOULEVARD WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1687
Practice Address - Country:US
Practice Address - Phone:719-542-8182
Practice Address - Fax:719-545-1585
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice