Provider Demographics
NPI:1659362812
Name:ALEXANDER, GUY DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:DOUGLAS
Last Name:ALEXANDER
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 1:3500 W CATON AVE
Mailing Address - Street 2:SIDE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3004
Mailing Address - Country:US
Mailing Address - Phone:410-945-9189
Mailing Address - Fax:
Practice Address - Street 1:3500 W CATON AVE SIDE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-945-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT60032Medicare UPIN