Provider Demographics
NPI:1780946467
Name:ROBERT M ALEXANDER DDS MS & BRANDON D MARTIN DDS MS A PC
Entity type:Organization
Organization Name:ROBERT M ALEXANDER DDS MS & BRANDON D MARTIN DDS MS A PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:916-630-0306
Mailing Address - Street 1:6809 FIVE STAR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2687
Mailing Address - Country:US
Mailing Address - Phone:916-630-0306
Mailing Address - Fax:
Practice Address - Street 1:6809 FIVE STAR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2687
Practice Address - Country:US
Practice Address - Phone:916-630-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455491223X0400X
CA569211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty