Provider Demographics
NPI:1134960719
Name:MICKOLOFF, ALAYNA (DMD)
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:
Last Name:MICKOLOFF
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 1:93 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2854
Mailing Address - Country:US
Mailing Address - Phone:724-344-7344
Mailing Address - Fax:
Practice Address - Street 1:5161 WILLIAM FLYNN HWY STE B
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8401
Practice Address - Country:US
Practice Address - Phone:724-939-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist