Provider Demographics
NPI:1922264282
Name:LUTSKIY, ALEKSANDR V (DMD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:V
Last Name:LUTSKIY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALEKSANDR
Other - Middle Name:V
Other - Last Name:LUTSKIY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4101 E WESLEY AVE
Mailing Address - Street 2:4
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 2:4
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
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice