1962646422 NPI number — DR. ALEJANDRO RODRIGUEZ KOVACS DDS

Table of content: DR. ALEJANDRO RODRIGUEZ KOVACS DDS (NPI 1962646422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962646422 NPI number — DR. ALEJANDRO RODRIGUEZ KOVACS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ KOVACS
Provider First Name:
ALEJANDRO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962646422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 EDEN AVE
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55436-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-929-0641
Provider Business Mailing Address Fax Number:
952-929-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 EDEN AVE
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55436-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-929-0641
Provider Business Practice Location Address Fax Number:
952-929-1802
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  D12641 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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