Provider Demographics
NPI:1982856183
Name:ALEXANDER, NICK EARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:EARL
Last Name:ALEXANDER
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 1:101 CUNNINGHAM BOULAVARD
Mailing Address - Street 2:NEMCC
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0000
Mailing Address - Country:US
Mailing Address - Phone:662-720-7283
Mailing Address - Fax:
Practice Address - Street 1:101 CUNNINGHAM BLVD
Practice Address - Street 2:NORTHEAST MS COMMUNITY COLLEGE
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1726
Practice Address - Country:US
Practice Address - Phone:662-720-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2527-90122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist