Provider Demographics
NPI:1639235690
Name:DOUVAS, ALEXANDRA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:N
Last Name:DOUVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20180 GOVERNORS HWY
Mailing Address - Street 2:SUITE #104
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-283-2207
Mailing Address - Fax:708-283-2209
Practice Address - Street 1:20180 GOVERNORS HWY
Practice Address - Street 2:SUITE #104
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-283-2207
Practice Address - Fax:708-283-2209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist