Provider Demographics
NPI:1043078793
Name:ALEXANDER HEATRICE DDS PC
Entity Type:Organization
Organization Name:ALEXANDER HEATRICE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-627-1953
Mailing Address - Street 1:2855 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1403
Mailing Address - Country:US
Mailing Address - Phone:314-627-1953
Mailing Address - Fax:314-897-3385
Practice Address - Street 1:2855 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1403
Practice Address - Country:US
Practice Address - Phone:314-627-1953
Practice Address - Fax:314-897-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400086802Medicaid