Provider Demographics
NPI:1215615091
Name:DZEKOLA, ANDREI (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:
Last Name:DZEKOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 OLYMPIC AVE APT 3123
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2286
Mailing Address - Country:US
Mailing Address - Phone:215-268-8825
Mailing Address - Fax:
Practice Address - Street 1:3360 W CACTUS AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8810
Practice Address - Country:US
Practice Address - Phone:702-527-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist