Provider Demographics
NPI:1598405862
Name:DEGENOVA, ALEXANDER DAVID (BS, MS, DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAVID
Last Name:DEGENOVA
Suffix:
Gender:M
Credentials:BS, MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 EVELYN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1044
Mailing Address - Country:US
Mailing Address - Phone:504-615-0066
Mailing Address - Fax:
Practice Address - Street 1:5529 CHERLYN DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1136
Practice Address - Country:US
Practice Address - Phone:504-615-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7643122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program