1790020352 NPI number — MR. DEVANTE KAWAND ALEXANDER I

Table of content: BRADLEY SAMUEL ISAACSON DDS (NPI 1427062819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790020352 NPI number — MR. DEVANTE KAWAND ALEXANDER I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
DEVANTE
Provider Middle Name:
KAWAND
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALEXANDER
Provider Other First Name:
DEVANTE
Provider Other Middle Name:
KAWAND
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790020352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3722 PARSONS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3722 PARSONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-258-1141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2012

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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