Provider Demographics
NPI:1346436870
Name:MEDINA, DAVID ALEJANDRO (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEJANDRO
Last Name:MEDINA
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 1:18014 WEBSTER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5594
Mailing Address - Country:US
Mailing Address - Phone:415-935-6042
Mailing Address - Fax:
Practice Address - Street 1:8915 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4813
Practice Address - Country:US
Practice Address - Phone:206-763-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist