Provider Demographics
NPI:1639514789
Name:DAMASCUS, ALEXANDER PAUL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:PAUL
Last Name:DAMASCUS
Suffix:III
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 1:3076 CARLETON PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6139
Mailing Address - Country:US
Mailing Address - Phone:408-248-0707
Mailing Address - Fax:
Practice Address - Street 1:3076 CARLETON PL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6139
Practice Address - Country:US
Practice Address - Phone:408-248-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27979122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice