=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548607120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANITA ALEXANDER DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2013
-----------------------------------------------------
Last Update Date | 05/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6760 GOODMAN RD
-----------------------------------------------------
City | OLIVE BRANCH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38654-7056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-895-3000
-----------------------------------------------------
Fax | 662-895-3021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6760 GOODMAN RD
-----------------------------------------------------
City | OLIVE BRANCH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38654-7056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-895-3000
-----------------------------------------------------
Fax | 662-895-3021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3686-13
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS0000009511
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------