Healthcare Provider Details

I. General information

NPI: 1225152051
Provider Name (Legal Business Name): THOMAS MONTE MCALEXANDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 N PARKWAY SUITE #2
JACKSON TN
38305-2857
US

IV. Provider business mailing address

468 N PARKWAY SUITE #2
JACKSON TN
38305-2857
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-3815
  • Fax: 731-664-3816
Mailing address:
  • Phone: 731-664-3815
  • Fax: 731-664-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS0000003552
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: