Provider Demographics
NPI:1710310271
Name:ALEKSANDR LUTSKIY, DMD, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:ALEKSANDR LUTSKIY, DMD, PROFESSIONAL LLC
Other - Org Name:ALL SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-758-3230
Mailing Address - Street 1:4101 E WESLEY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6050
Mailing Address - Country:US
Mailing Address - Phone:303-758-3230
Mailing Address - Fax:303-758-3552
Practice Address - Street 1:4101 E WESLEY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6050
Practice Address - Country:US
Practice Address - Phone:303-758-3230
Practice Address - Fax:303-758-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06675883Medicaid