Provider Demographics
NPI:1275855215
Name:ALEX, THOMAS GARRY (DMD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GARRY
Last Name:ALEX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 COVE ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-421-4408
Mailing Address - Fax:631-423-8009
Practice Address - Street 1:90 COVE ROAD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-4408
Practice Address - Fax:631-423-8009
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY358621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice