Provider Demographics
NPI:1083282883
Name:KITAYGORODSKIY, ALEKSANDR (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDR
Middle Name:
Last Name:KITAYGORODSKIY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 1206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6212
Mailing Address - Country:US
Mailing Address - Phone:215-545-5592
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 1206
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6212
Practice Address - Country:US
Practice Address - Phone:215-545-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0442241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty