Provider Demographics
NPI:1083376123
Name:COLLINS-HORNYAK, ALEXANDER (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:COLLINS-HORNYAK
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 1:9820 EAGLE ROCK AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3913
Mailing Address - Country:US
Mailing Address - Phone:505-573-7140
Mailing Address - Fax:
Practice Address - Street 1:232 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2623
Practice Address - Country:US
Practice Address - Phone:505-573-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD55371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice