Provider Demographics
NPI:1467813626
Name:GRITSAN, ALINA (DDS)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:GRITSAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 QUEENS CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7375
Mailing Address - Country:US
Mailing Address - Phone:636-928-4441
Mailing Address - Fax:636-922-3665
Practice Address - Street 1:1325 QUEENS CT
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7375
Practice Address - Country:US
Practice Address - Phone:636-928-4441
Practice Address - Fax:636-922-3665
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist