Provider Demographics
NPI:1477527539
Name:ALEXANDER, RANDOLPH HUNTER (DDS)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:HUNTER
Last Name:ALEXANDER
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 1:2708 ASTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8824
Mailing Address - Country:US
Mailing Address - Phone:337-478-9843
Mailing Address - Fax:337-478-9845
Practice Address - Street 1:2708 ASTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8824
Practice Address - Country:US
Practice Address - Phone:337-478-9843
Practice Address - Fax:337-478-9845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1828963Medicaid
LAT19753Medicare UPIN
LA1828963Medicaid