Provider Demographics
NPI:1720219660
Name:ALEXANDER, CANDACE ((DDS))
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:ALEXANDER
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 1:863 FLAT SHOALS RD SE SUITE C #220
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:301-580-5838
Mailing Address - Fax:
Practice Address - Street 1:863 FLAT SHOALS RD SE, SUITE C #220
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:301-580-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist