Healthcare Provider Details

I. General information

NPI: 1194404665
Provider Name (Legal Business Name): ALEX HSIEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

IV. Provider business mailing address

1602 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-9175
  • Fax:
Mailing address:
  • Phone: 541-440-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD12404
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES-30679
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62120
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: