Healthcare Provider Details

I. General information

NPI: 1013713981
Provider Name (Legal Business Name): ALEXANDER JAMES FAZEKAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FORT ST
TRENTON MI
48183-2040
US

IV. Provider business mailing address

114 W ADAMS AVE APT 1104
DETROIT MI
48226-1632
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-8400
  • Fax:
Mailing address:
  • Phone: 517-442-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: