Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7083 | IN |
NPI | 1053484600 |
---|---|
Provider Name | Dr. David Alexander |
First Address | Lafayette, IN 47904-2895 |
Second Address | Lafayette, IN 47904-2895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |