Provider Demographics
NPI:1821772328
Name:EYZIPS, ALEXSANDR (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXSANDR
Middle Name:
Last Name:EYZIPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NEWBURY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4552
Mailing Address - Country:US
Mailing Address - Phone:215-808-4243
Mailing Address - Fax:
Practice Address - Street 1:1318 FRANKLIN MILLS CIR # 807
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3130
Practice Address - Country:US
Practice Address - Phone:215-632-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist