Provider Demographics
NPI:1013363662
Name:HUNG, ALEXANDRA (RDH)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HUNG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 ROCK CREEK DRIVE, UNIT B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-232-6170
Mailing Address - Fax:
Practice Address - Street 1:1241 RIVERSIDE AVE.
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-232-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2022-07-21
Deactivation Date:2017-09-19
Deactivation Code:
Reactivation Date:2017-11-28
Provider Licenses
StateLicense IDTaxonomies
CO002023867124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist