Provider Demographics
NPI:1902954688
Name:ALEXANDER, GARY A (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OAK CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1790
Mailing Address - Country:US
Mailing Address - Phone:281-554-6817
Mailing Address - Fax:281-554-6817
Practice Address - Street 1:1824 B NORTH VELASCO
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-849-0280
Practice Address - Fax:979-849-4516
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice