Provider Demographics
NPI:1568611275
Name:MOLAYEM, ALEXANDER KAMRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:KAMRAN
Last Name:MOLAYEM
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 1:4731 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3835
Mailing Address - Country:US
Mailing Address - Phone:817-531-0431
Mailing Address - Fax:817-531-2389
Practice Address - Street 1:4731 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3835
Practice Address - Country:US
Practice Address - Phone:817-531-0431
Practice Address - Fax:817-531-2389
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247161223G0001X
NYP651901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice