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General NPI Number Information
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NPI Number | 1699506618
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Entity Type | Individual
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Provider Name | ALEXANDER KOO DMD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 900 W TRADE ST STE 120
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City | CHARLOTTE
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State | NC
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Zip | 28202-1144
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Country | US
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Telephone | 704-332-9848
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E BROOKLYN VILLAGE AVE UNIT 744
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City | CHARLOTTE
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State | NC
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Zip | 28202-3623
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Country | US
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Telephone | 864-363-8252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 13943
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License Number State | NC
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