Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS035834 | PA |
NPI | 1003968769 |
---|---|
Provider Name | Dr. Alexandr Volchonok |
First Address | Feasterville Trevose, PA 19053-2318 |
Second Address | Feasterville Trevose, PA 19053-2318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 27/08/2012 |