Provider Demographics
NPI:1871849802
Name:PODARU, ALEX (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:PODARU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:PODARU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2245 NW 5TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32603-1408
Mailing Address - Country:US
Mailing Address - Phone:518-512-1923
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D10-6
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0434
Practice Address - Country:US
Practice Address - Phone:352-273-8360
Practice Address - Fax:352-273-6192
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2169101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR1063OtherDR ID NUMBER