Provider Demographics
NPI:1427734227
Name:SIDEHAMER, ALEC KARL (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEC
Middle Name:KARL
Last Name:SIDEHAMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 OLD FRANKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-7167
Mailing Address - Country:US
Mailing Address - Phone:814-931-1900
Mailing Address - Fax:
Practice Address - Street 1:440 ERIE PKWY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5435
Practice Address - Country:US
Practice Address - Phone:303-953-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
CODEN.002057011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program