Provider Demographics
NPI:1184319337
Name:HUBRECHT, ALEXANDER CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHARLES
Last Name:HUBRECHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N PENNSYLVANIA ST APT 514
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2293
Mailing Address - Country:US
Mailing Address - Phone:317-730-5014
Mailing Address - Fax:
Practice Address - Street 1:9126 TECHNOLOGY LN STE 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3094
Practice Address - Country:US
Practice Address - Phone:317-598-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN12014594A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300102462Medicaid