Provider Demographics
NPI:1891445755
Name:LUSK, ALEXANDER COLBY (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:COLBY
Last Name:LUSK
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 1:1628 WEST 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661
Mailing Address - Country:US
Mailing Address - Phone:304-236-2366
Mailing Address - Fax:865-305-9442
Practice Address - Street 1:1628 WEST 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-236-2366
Practice Address - Fax:865-305-9442
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist