Provider Demographics
NPI:1629685920
Name:ALEXANDROFF DMD PC
Entity Type:Organization
Organization Name:ALEXANDROFF DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FAGD
Authorized Official - Phone:503-325-3230
Mailing Address - Street 1:1630 SE ENSIGN LANE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-325-3230
Mailing Address - Fax:503-717-8790
Practice Address - Street 1:1085 E HARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-861-3707
Practice Address - Fax:503-861-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty