Provider Demographics
NPI:1215628516
Name:CACERES, ALEX D SR
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:D
Last Name:CACERES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 E HWY 50 STE 100
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5199
Mailing Address - Country:US
Mailing Address - Phone:352-327-8957
Mailing Address - Fax:
Practice Address - Street 1:1645 E HWY 50 STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5199
Practice Address - Country:US
Practice Address - Phone:352-327-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice