Healthcare Provider Details

I. General information

NPI: 1134517477
Provider Name (Legal Business Name): STEVEN ALEXANDER DDS, MSD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 AVIATION RD BLDG A
QUEENSBURY NY
12804-2915
US

IV. Provider business mailing address

333 AVIATION RD BLDG A
QUEENSBURY NY
12804-2915
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-8511
  • Fax: 518-793-8588
Mailing address:
  • Phone: 518-793-8511
  • Fax: 518-793-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number057600-1
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN ALEXANDER
Title or Position: PRESIDENT
Credential: DDS, MSD
Phone: 518-793-8511