Healthcare Provider Details

I. General information

NPI: 1962105098
Provider Name (Legal Business Name): ALEXANDER Y LI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 MAIN ST
SPRINGFIELD MA
01103-1077
US

IV. Provider business mailing address

2107 MULLINGAR ST
CARY NC
27518-7716
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-5600
  • Fax:
Mailing address:
  • Phone: 919-448-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number112498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: