Provider Demographics
NPI:1811188824
Name:ALEXANDROFF, ROMAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:A
Last Name:ALEXANDROFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ROMAN
Other - Middle Name:A
Other - Last Name:TYUKALOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:1630 SE ENSIGN LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-717-3566
Mailing Address - Fax:503-717-8790
Practice Address - Street 1:1630 SE ENSIGN LN.
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-325-3230
Practice Address - Fax:503-717-8790
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist