Healthcare Provider Details

I. General information

NPI: 1609031137
Provider Name (Legal Business Name): GEORGE ALEXANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
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
US

V. Phone/Fax

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

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:
Title or Position:
Credential:
Phone: