Provider Demographics
NPI:1275785545
Name:RIBEIRO, ALEXANDRE LOMBARDI VIDAL LEITE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:LOMBARDI VIDAL LEITE
Last Name:RIBEIRO
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 1:6202 OSPREY TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2619
Mailing Address - Country:US
Mailing Address - Phone:305-905-7537
Mailing Address - Fax:
Practice Address - Street 1:817 S UNIVERSITY DR STE 107
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3345
Practice Address - Country:US
Practice Address - Phone:954-476-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119321223P0300X
FLDN191531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics