Provider Demographics
NPI:1184122681
Name:ALEX DENTAL PC
Entity type:Organization
Organization Name:ALEX DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-659-5986
Mailing Address - Street 1:2311 M ST NW STE 404
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1468
Mailing Address - Country:US
Mailing Address - Phone:202-659-5986
Mailing Address - Fax:
Practice Address - Street 1:2311 M ST NW STE 404
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1468
Practice Address - Country:US
Practice Address - Phone:202-659-5986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental