Provider Demographics
NPI:1104603992
Name:AMRO, ALEXANDRE (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:AMRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2828
Mailing Address - Country:US
Mailing Address - Phone:650-664-7826
Mailing Address - Fax:
Practice Address - Street 1:554 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2828
Practice Address - Country:US
Practice Address - Phone:650-664-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist