Alexander John Krisko, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12693 Issued in NC

Practice address

3452 Graystone PL SE
Conover, NC 28613-8200

Phone

(828) 322-1667

NPI assigned

Mar 28, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 21, 2023 through Jul 21, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: akrisko22326@ukhcdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS. Darab and Richardson, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Conover, NC
  • NPI 1841340049
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1205368495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2526",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286032526",
            "telephone_number": "828-322-1667",
            "fax_number": "828-324-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3452 GRAYSTONE PL SE",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286138200",
            "telephone_number": "828-322-1667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1306 Davie Ave",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286773514",
            "country_code": "US",
            "telephone_number": "704-873-6988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRISKO",
        "first_name": "ALEXANDER",
        "middle_name": "JOHN",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "9962",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "12693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tou Shonpov Khang, RPH
• Michelle Lynn Kirby, R.PH, CMF
• Lauren Ann Kiziah, PHARMD
• Alexis Komornik, CPNP
• Anastasia Cherie Elizabeth Kosiske, MD
• Samantha Lackey
• Carol Lands, PA
• Thomas F Laney Jr., MD
• Bee Lao
• Larissa M. Mastro, DDS, P.a.

• Oral and Maxillofacial Surgery (Dentist) in Conover, NC
• Providers in Conover, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.