Provider Demographics
NPI:1407960925
Name:LEBEDEN, ALEXANDER (DDS PC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:LEBEDEN
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1135
Mailing Address - Country:US
Mailing Address - Phone:718-897-5900
Mailing Address - Fax:718-897-6331
Practice Address - Street 1:9330 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1135
Practice Address - Country:US
Practice Address - Phone:718-897-5900
Practice Address - Fax:718-897-6331
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00395253Medicaid