Provider Demographics
NPI:1184993487
Name:ALEXANDER A. DUTKO, D.D.S., P.C.
Entity type:Organization
Organization Name:ALEXANDER A. DUTKO, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:ASKOLD
Authorized Official - Last Name:DUTKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-558-9666
Mailing Address - Street 1:29439 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2203
Mailing Address - Country:US
Mailing Address - Phone:586-558-9666
Mailing Address - Fax:586-558-8121
Practice Address - Street 1:29439 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2203
Practice Address - Country:US
Practice Address - Phone:586-558-9666
Practice Address - Fax:586-558-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010151601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty