Provider Demographics
NPI:1982388070
Name:ALEXANDER, DEXTER MAURICE SR (SA-C)
Entity Type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:MAURICE
Last Name:ALEXANDER
Suffix:SR
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 COLD CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8137
Mailing Address - Country:US
Mailing Address - Phone:419-366-0487
Mailing Address - Fax:
Practice Address - Street 1:1125 TREYBROOKE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9156
Practice Address - Country:US
Practice Address - Phone:252-717-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01-181246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant