=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437751195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M ALEXANDRUNAS D HUDOBA DENTAL 1 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2020
-----------------------------------------------------
Last Update Date | 11/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 W COSHOCTON ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43031-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-967-1444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 822
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43054-0822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK R. ALEXANDRUNAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-587-4891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------