Provider Demographics
NPI:1821612201
Name:DORROUGH, ALEXANDER (DDS CAS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DORROUGH
Suffix:
Gender:M
Credentials:DDS CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ABBEY LN UNIT 3320
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5221
Mailing Address - Country:US
Mailing Address - Phone:860-985-1518
Mailing Address - Fax:
Practice Address - Street 1:19 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2134
Practice Address - Country:US
Practice Address - Phone:914-594-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist