Provider Demographics
NPI:1043478423
Name:CANOSA, ALEJANDRO (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:CANOSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5251 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5025
Mailing Address - Country:US
Mailing Address - Phone:305-648-2880
Mailing Address - Fax:
Practice Address - Street 1:5251 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5025
Practice Address - Country:US
Practice Address - Phone:305-648-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist