Provider Demographics
NPI:1275235996
Name:CAIN, ALEX GLADSTONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:GLADSTONE
Last Name:CAIN
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 1:3248 HARNESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1616
Mailing Address - Country:US
Mailing Address - Phone:443-834-9314
Mailing Address - Fax:
Practice Address - Street 1:27132 MAIN ST UNIT 200
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-8523
Practice Address - Country:US
Practice Address - Phone:303-816-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.00205920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program