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General NPI Number Information
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NPI Number | 1952883316
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Entity Type | Individual
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Provider Name | ALEX MA DDS
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Gender | Male
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Dates
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Enumeration Date | 09/02/2018
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 303 COLUMBUS AVE
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City | BOSTON
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State | MA
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Zip | 02116-5284
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Country | US
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Telephone | 617-449-3608
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Fax |
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Provider Business Mailing Address
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Address Line | 56 CLYDE ST UNIT 1
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City | SOMERVILLE
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State | MA
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Zip | 02145-3524
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Country | US
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Telephone | 815-238-8141
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858090
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License Number State | MA
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