Provider Demographics
NPI:1235798927
Name:SMITH, ALEXANDER JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:SMITH
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 1:431 SUMMIT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3861
Mailing Address - Country:US
Mailing Address - Phone:616-403-3778
Mailing Address - Fax:
Practice Address - Street 1:431 SUMMIT ST STE 105
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3861
Practice Address - Country:US
Practice Address - Phone:616-403-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist