Healthcare Provider Details

I. General information

NPI: 1598854929
Provider Name (Legal Business Name): DMITRI VLADISLAVOVICH ALEKSANDROV DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST STE 210
GRESHAM OR
97030-7341
US

IV. Provider business mailing address

1717 SW PARK AVE APT 505
PORTLAND OR
97201-3237
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-4900
  • Fax:
Mailing address:
  • Phone: 503-679-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8451
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: