Provider Demographics
NPI:1548607120
Name:ALEXANDER, JANITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANITA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7056
Mailing Address - Country:US
Mailing Address - Phone:662-895-3000
Mailing Address - Fax:662-895-3021
Practice Address - Street 1:6760 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7056
Practice Address - Country:US
Practice Address - Phone:662-895-3000
Practice Address - Fax:662-895-3021
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3686-13122300000X
TNDS0000009511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist