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General NPI Number Information
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NPI Number | 1811312705
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Entity Type | Individual
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Provider Name | ALIAKSANDR KURSHUK DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 2240 E MITCHELL RD UNIT 3
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City | PETOSKEY
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State | MI
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Zip | 49770-6602
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Country | US
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Telephone | 231-881-9596
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Fax | 231-881-9598
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Provider Business Mailing Address
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Address Line | 2240 E MITCHELL RD UNIT 3
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City | PETOSKEY
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State | MI
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Zip | 49770-6602
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Country | US
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Telephone | 231-881-9596
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Fax | 231-881-9598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12011766A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901021459
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License Number State | MI
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