Healthcare Provider Details

I. General information

NPI: 1780658039
Provider Name (Legal Business Name): ALEXANDRE AALAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E BELL RD SUITE 104
PHOENIX AZ
85022
US

IV. Provider business mailing address

706 E BELL RD SUITE 104
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-7700
  • Fax: 602-787-1578
Mailing address:
  • Phone: 602-482-7000
  • Fax: 602-482-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD6368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: