Healthcare Provider Details

I. General information

NPI: 1790078574
Provider Name (Legal Business Name): ALEXANDER HEATRICE DDS, MPH,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER HEATRICE II DDS

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ BLDG SUITE230
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

1 BARNES JEWISH HOSPITAL PLZ BLDG SUITE230
SAINT LOUIS MO
63110-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-6006
  • Fax: 314-453-1675
Mailing address:
  • Phone: 314-361-6006
  • Fax: 314-453-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2020012236
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: