Provider Demographics
NPI:1306803952
Name:SHCHIPKOV, ALEX Y (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:Y
Last Name:SHCHIPKOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PINE WEST PLZ
Mailing Address - Street 2:WASHINGTON AVE EXTENSION
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5587
Mailing Address - Country:US
Mailing Address - Phone:518-456-7673
Mailing Address - Fax:518-456-8369
Practice Address - Street 1:5 PINE WEST PLZ
Practice Address - Street 2:WASHINGTON AVE EXTENSION
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5587
Practice Address - Country:US
Practice Address - Phone:518-456-7673
Practice Address - Fax:518-456-8369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700723Medicaid