Provider Demographics
NPI:1598854929
Name:ALEKSANDROV, DMITRI VLADISLAVOVICH (DMD)
Entity type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:VLADISLAVOVICH
Last Name:ALEKSANDROV
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 1:1717 SW PARK AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3237
Mailing Address - Country:US
Mailing Address - Phone:503-679-0865
Mailing Address - Fax:
Practice Address - Street 1:600 NE 8TH ST STE 210
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7341
Practice Address - Country:US
Practice Address - Phone:503-988-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice