Provider Demographics
NPI:1679723936
Name:DANSA, ALEXANDER JINDU
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JINDU
Last Name:DANSA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:JINDU
Other - Last Name:DANSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2500 GUADALAJARA DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7898
Mailing Address - Country:US
Mailing Address - Phone:209-595-6946
Mailing Address - Fax:
Practice Address - Street 1:2500 GUADALAJARA DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-7898
Practice Address - Country:US
Practice Address - Phone:209-595-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist