Provider Demographics
NPI:1871939462
Name:LATSILNIK, ALEXEY BORISOVICH (DMD)
Entity type:Individual
Prefix:MR
First Name:ALEXEY
Middle Name:BORISOVICH
Last Name:LATSILNIK
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 1:321 LAFAYETTE RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2158
Mailing Address - Country:US
Mailing Address - Phone:603-929-3969
Mailing Address - Fax:603-929-3997
Practice Address - Street 1:321 LAFAYETTE RD
Practice Address - Street 2:UNIT B
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2158
Practice Address - Country:US
Practice Address - Phone:603-929-3969
Practice Address - Fax:603-929-3997
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice