Healthcare Provider Details

I. General information

NPI: 1992481170
Provider Name (Legal Business Name): ALEXANDER EASON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 CANAL ST, JACKSONVILLE, NC 28540
FPO AA
28540
US

IV. Provider business mailing address

670 BOULEVARD DE FRANCE, MCRD PARRIS ISLAND, SC
FPO AA
29905-0000
US

V. Phone/Fax

Practice location:
  • Phone: 517-614-0251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28014
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14638
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: