Provider Demographics
NPI:1205808235
Name:EHRLICH, ALEX DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DALE
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:3001 6TH ST
Mailing Address - Street 2:PROFESSIONAL AFFAIRS COORDINATOR NAVAL HOSPITAL
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-2833
Mailing Address - Country:US
Mailing Address - Phone:847-688-5647
Mailing Address - Fax:847-688-4279
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:PROFESSIONAL AFFAIRS COORDINATOR NAVAL HOSPITAL
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-5647
Practice Address - Fax:847-688-4279
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007771A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice