Provider Demographics
NPI:1316029002
Name:BANKHEAD, ALEX SPENCE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:SPENCE
Last Name:BANKHEAD
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1375 E 800 N
Mailing Address - Street 2:STE 104
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4435
Mailing Address - Country:US
Mailing Address - Phone:801-221-7799
Mailing Address - Fax:801-221-9559
Practice Address - Street 1:1375 E 800 N
Practice Address - Street 2:STE 104
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4435
Practice Address - Country:US
Practice Address - Phone:801-221-7799
Practice Address - Fax:801-221-9559
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34712399231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics