Provider Demographics
NPI:1316232614
Name:TITUS, ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:TITUS
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 1:370 MEDICAL DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-844-8292
Mailing Address - Fax:
Practice Address - Street 1:370 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2916
Practice Address - Country:US
Practice Address - Phone:317-844-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011636A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist