Healthcare Provider Details

I. General information

NPI: 1669869921
Provider Name (Legal Business Name): M. ALEXANDRUNAS, DMD-DENTAL 1, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 MILTON CT
NEW ALBANY OH
43054-9038
US

IV. Provider business mailing address

7365 MILTON CT
NEW ALBANY OH
43054-9038
US

V. Phone/Fax

Practice location:
  • Phone: 614-425-9059
  • Fax: 614-283-5020
Mailing address:
  • Phone: 614-425-9059
  • Fax: 614-283-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30022273
License Number StateOH

VIII. Authorized Official

Name: DR. MARK ALEXANDRUNAS
Title or Position: PRINCIPAL OWNER
Credential: DMD
Phone: 614-425-9061