Provider Demographics
NPI:1801493762
Name:AHMADI, ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 CHOUTEAU AVE APT 456
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1770
Mailing Address - Country:US
Mailing Address - Phone:260-403-8886
Mailing Address - Fax:
Practice Address - Street 1:4171 CRESCENT DR STE 102
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3645
Practice Address - Country:US
Practice Address - Phone:314-200-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200327251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice