Provider Demographics
NPI:1245750439
Name:M. ALEXANDRUNAS, DMD, B. MASON, DDS, R. GARDNER, DD-DENTAL 3, LLC
Entity Type:Organization
Organization Name:M. ALEXANDRUNAS, DMD, B. MASON, DDS, R. GARDNER, DD-DENTAL 3, LLC
Other - Org Name:PREMIER DENTAL OF CIRCLEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDRUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-425-9061
Mailing Address - Street 1:1422 CIRCLEVILLE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2269
Mailing Address - Country:US
Mailing Address - Phone:614-425-9059
Mailing Address - Fax:
Practice Address - Street 1:1422 CIRCLEVILLE PLAZA DR
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2269
Practice Address - Country:US
Practice Address - Phone:740-474-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.020068122300000X
OH30.022273122300000X
OH30.0217631223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty