Provider Demographics
NPI:1821132341
Name:PAGONIS, ALEX E (DDS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:E
Last Name:PAGONIS
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 1:10383 TORRE AVE SUITE I
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-257-3031
Mailing Address - Fax:408-257-5842
Practice Address - Street 1:10383 TORRE AVE SUITE I
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-257-3031
Practice Address - Fax:408-257-5842
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist