Provider Demographics
NPI:1558581108
Name:SULPOVAR, ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:SULPOVAR
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 1:179 YORK RD
Mailing Address - Street 2:STE. 2
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4536
Mailing Address - Country:US
Mailing Address - Phone:215-394-5558
Mailing Address - Fax:215-394-5644
Practice Address - Street 1:179 YORK RD
Practice Address - Street 2:STE. 2
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4536
Practice Address - Country:US
Practice Address - Phone:215-394-5558
Practice Address - Fax:215-394-5644
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022563001223G0001X
PADS0355011223G0001X
MO20001642281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice