Healthcare Provider Details

I. General information

NPI: 1962186734
Provider Name (Legal Business Name): ALEXANDER HOMER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 E FLORIAN AVE STE 104
MESA AZ
85206-2688
US

IV. Provider business mailing address

5750 S 101ST WAY
MESA AZ
85212-1165
US

V. Phone/Fax

Practice location:
  • Phone: 480-396-6100
  • Fax:
Mailing address:
  • Phone: 605-759-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD012471
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: