Provider Demographics
NPI:1548382369
Name:KRALIEVITCH, ALEXANDRA (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KRALIEVITCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5931
Mailing Address - Country:US
Mailing Address - Phone:315-797-1807
Mailing Address - Fax:
Practice Address - Street 1:1714 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1002
Practice Address - Country:US
Practice Address - Phone:315-624-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP51795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP51795OtherNEW YORK STATE PERMIT