Provider Demographics
NPI:1265056782
Name:BOUMERHI, ALEXANDER FARID (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:FARID
Last Name:BOUMERHI
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 1:439 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-1702
Mailing Address - Country:US
Mailing Address - Phone:814-553-7984
Mailing Address - Fax:
Practice Address - Street 1:439 SPRING ST
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651-1702
Practice Address - Country:US
Practice Address - Phone:814-553-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist