Provider Demographics
NPI:1053304162
Name:ANTONAKOS, ALEXANDER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:J
Last Name:ANTONAKOS
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 1:23 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3118
Mailing Address - Country:US
Mailing Address - Phone:860-529-0170
Mailing Address - Fax:
Practice Address - Street 1:23 GARDEN ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3118
Practice Address - Country:US
Practice Address - Phone:860-529-0170
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist