Provider Demographics
NPI:1700967544
Name:SHOR, ALEXANDER (DMD MSD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:SHOR
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FAIRVIEW AVE EAST
Mailing Address - Street 2:STE NO 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-325-7456
Mailing Address - Fax:206-323-6273
Practice Address - Street 1:1500 FAIRVIEW AVE EAST
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-325-7456
Practice Address - Fax:206-323-6273
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics