MEDICARE: ALEXANDER AZUMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7749	NV

General Provider Information

NPI Number	:	1023713930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER AZUMA

Provider Business Mailing Address
First Line	:	3600 CAMBRIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 CAMBRIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4003
Country	:	US
Telephone Number	:	702-485-1778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “ ALEXANDER AZUMA ” Practice Location

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