Provider Demographics
NPI:1538681010
Name:THANH, ALEX (DMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:THANH
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 1:2964 SW 35TH PL APT 75
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9358
Mailing Address - Country:US
Mailing Address - Phone:407-733-3323
Mailing Address - Fax:
Practice Address - Street 1:7007 LELY CULTURAL PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8976
Practice Address - Country:US
Practice Address - Phone:239-775-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN266991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry