Healthcare Provider Details

I. General information

NPI: 1588684070
Provider Name (Legal Business Name): GEORGE ALEXANDER,DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 HARDING BLVD
COTTER AR
72626-9770
US

IV. Provider business mailing address

1629 HARDING BLVD
COTTER AR
72626-9770
US

V. Phone/Fax

Practice location:
  • Phone: 870-435-6669
  • Fax: 870-435-2191
Mailing address:
  • Phone: 870-435-6669
  • Fax: 870-435-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2889
License Number StateAR

VIII. Authorized Official

Name: DR. GEORGE ALEXANDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 870-435-6669