Provider Demographics
NPI:1720106982
Name:ALEKSEY FUKS,D.D.S., INC.
Entity type:Organization
Organization Name:ALEKSEY FUKS,D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-980-7222
Mailing Address - Street 1:11300 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3772
Mailing Address - Country:US
Mailing Address - Phone:818-980-7222
Mailing Address - Fax:818-508-1770
Practice Address - Street 1:11300 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3772
Practice Address - Country:US
Practice Address - Phone:818-980-7222
Practice Address - Fax:818-508-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89900-01Medicaid