MEDICARE: DR. ALEXIS MARIE PLUCINSKY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.027150	OH

General Provider Information

NPI Number	:	1730879032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS MARIE PLUCINSKY DMD

Provider Business Mailing Address
First Line	:	7249 WINCHESTER DR
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-4819
Country	:	US
Telephone Number	:	440-289-1554
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 S GREEN RD STE 157
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4122
Country	:	US
Telephone Number	:	216-381-6521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/10/2023

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