Provider Demographics
NPI:1447983176
Name:FURTADO, ALEXANDRA JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:JANE
Last Name:FURTADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JANE
Other - Last Name:ERRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 LIELMANIS AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5613
Mailing Address - Country:US
Mailing Address - Phone:850-881-3922
Mailing Address - Fax:
Practice Address - Street 1:HURLBURT FIELD, 113 LIELMANIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-881-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN274701223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice