Provider Demographics
NPI:1629252796
Name:KASIRI, ALEXANDER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:M
Last Name:KASIRI
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 1:3509 E PARK BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:972-509-9399
Mailing Address - Fax:972-509-5346
Practice Address - Street 1:3509 E PARK BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:972-509-9399
Practice Address - Fax:972-509-5346
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1417735-01Medicaid
TX1417735-02Medicaid