Provider Demographics
NPI:1255727996
Name:CIBOR, ALEXANDER VAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:VAN
Last Name:CIBOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 OTTAWA BEACH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2528
Mailing Address - Country:US
Mailing Address - Phone:616-288-4777
Mailing Address - Fax:
Practice Address - Street 1:1121 OTTAWA BEACH RD STE 100
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2528
Practice Address - Country:US
Practice Address - Phone:616-288-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60654296122300000X
MI29016012491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist