=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215420302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN ALEXANDER ALVEY DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2018
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1139A GREENVILLE HWY
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-693-8630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1139A GREENVILLE HWY
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-693-8630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 11306
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------