Provider Demographics
NPI:1124868104
Name:ALEXANDER, BRENT CHARLES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:CHARLES
Last Name:ALEXANDER
Suffix:JR
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 1:2103 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3516
Mailing Address - Country:US
Mailing Address - Phone:318-366-7557
Mailing Address - Fax:
Practice Address - Street 1:2103 OAKMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3516
Practice Address - Country:US
Practice Address - Phone:318-366-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist