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General NPI Number Information
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NPI Number | 1619484110
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Entity Type | Organization
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Legal Business Name | ALEXANDRA N. DOUVAS
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 20180 GOVERNORS HWY, STE 104
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 708-283-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 3950 N. LAKE SHORE DR, UNIT 430
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 708-283-2207
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDRA N. DOUVAS
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Credential | DDS
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Telephone | 708-283-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019022594
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License Number State | IL
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