Provider Demographics
NPI:1821392275
Name:ALEXANDER, ADAM A (DMD, PHD, EDD, MS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:A
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DMD, PHD, EDD, MS
Other - Prefix:
Other - First Name:AHMAD
Other - Middle Name:
Other - Last Name:ABDELKARIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, PHD, EDD, MS
Mailing Address - Street 1:2500 N. STATE STREET
Mailing Address - Street 2:D315
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:904-314-5353
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:904-314-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3673-12122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist