Healthcare Provider Details

I. General information

NPI: 1902950421
Provider Name (Legal Business Name): RICARDO ALEXANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HIGH STREET SUITE 308
HUNTINGTON NY
11743-3417
US

IV. Provider business mailing address

7 HIGH STREET SUITE 308
HUNTINGTON NY
11743-3417
US

V. Phone/Fax

Practice location:
  • Phone: 631-547-8324
  • Fax: 631-271-1148
Mailing address:
  • Phone: 631-547-8324
  • Fax: 631-271-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number042103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: