Provider Demographics
NPI:1881439578
Name:STODDARD, ALEXANDER (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:STODDARD
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 1:5823 PALMER RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5128
Mailing Address - Country:US
Mailing Address - Phone:574-551-5441
Mailing Address - Fax:
Practice Address - Street 1:1720 TAMIAMI TRL STE 102
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1121
Practice Address - Country:US
Practice Address - Phone:941-584-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist