Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | ETN741 | TX |
NPI | 1003411752 |
---|---|
Provider Name | Dr. Alexander John Debernardo |
First Address | Seabrook, TX 77586-4614 |
Second Address | Houston, TX 77030-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2020 |
Last Update Date | 01/12/2020 |