Provider Demographics
NPI:1356514772
Name:ALEXANDER DENTAL GROUOP CHTD.
Entity type:Organization
Organization Name:ALEXANDER DENTAL GROUOP CHTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-7566
Mailing Address - Street 1:506 HANSEN ST E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6254
Mailing Address - Country:US
Mailing Address - Phone:208-733-7566
Mailing Address - Fax:208-734-4267
Practice Address - Street 1:506 HANSEN ST E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6254
Practice Address - Country:US
Practice Address - Phone:208-733-7566
Practice Address - Fax:208-734-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID181859OtherIDAHO SMILES