Healthcare Provider Details

I. General information

NPI: 1154711687
Provider Name (Legal Business Name): DAVID M ALEX DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 E MCANDREWS RD
MEDFORD OR
97504-6103
US

IV. Provider business mailing address

1291 E MCANDREWS RD
MEDFORD OR
97504-6103
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-8923
  • Fax: 541-779-9620
Mailing address:
  • Phone: 541-779-8923
  • Fax: 541-779-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD4909
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID MERLE ALEX
Title or Position: PRESIDENT
Credential: DDS
Phone: 541-779-8923