Provider Demographics
NPI:1811312705
Name:KURSHUK, ALIAKSANDR (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:ALIAKSANDR
Middle Name:
Last Name:KURSHUK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E MITCHELL RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-6602
Mailing Address - Country:US
Mailing Address - Phone:231-881-9596
Mailing Address - Fax:231-881-9598
Practice Address - Street 1:2240 E MITCHELL RD UNIT 3
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-6602
Practice Address - Country:US
Practice Address - Phone:231-881-9596
Practice Address - Fax:231-881-9598
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011766A1223X0400X
MI29010214591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics