Provider Demographics
NPI:1679726442
Name:HRONKIN, JESSE GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:GEORGE
Last Name:HRONKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 E WESTPOINT DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7137
Mailing Address - Country:US
Mailing Address - Phone:907-373-2232
Mailing Address - Fax:907-373-2439
Practice Address - Street 1:936 E WESTPOINT DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7137
Practice Address - Country:US
Practice Address - Phone:907-373-2232
Practice Address - Fax:907-373-2439
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD11231Medicaid