Provider Demographics
NPI:1598776924
Name:ALEXANDER, KELLY DREW JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DREW
Last Name:ALEXANDER
Suffix:JR
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 1:104 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748
Mailing Address - Country:US
Mailing Address - Phone:662-827-2922
Mailing Address - Fax:662-827-2922
Practice Address - Street 1:104 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748
Practice Address - Country:US
Practice Address - Phone:662-827-2922
Practice Address - Fax:662-827-2922
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS104962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060035Medicaid