Healthcare Provider Details

I. General information

NPI: 1144676677
Provider Name (Legal Business Name): ALEXANDER MARGOLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 01/20/2024
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 W HILLSBORO BLVD STE C
DEERFIELD BEACH FL
33442-1114
US

IV. Provider business mailing address

16 WALNUT ST UNIT B
SUMMIT NJ
07901-3543
US

V. Phone/Fax

Practice location:
  • Phone: 561-289-2752
  • Fax:
Mailing address:
  • Phone: 561-843-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN22462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: