Provider Demographics
NPI:1508104597
Name:AA DENTAL PLLC
Entity Type:Organization
Organization Name:AA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-463-7972
Mailing Address - Street 1:113 SW 11 CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315
Mailing Address - Country:US
Mailing Address - Phone:954-463-7972
Mailing Address - Fax:954-764-5916
Practice Address - Street 1:113 SW 11TH CT
Practice Address - Street 2:SUITE A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1271
Practice Address - Country:US
Practice Address - Phone:954-463-7972
Practice Address - Fax:954-764-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18817261QD0000X
FLDN16636261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental