Provider Demographics
NPI:1699506618
Name:KOO, ALEXANDER (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KOO
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 1:400 E BROOKLYN VILLAGE AVE UNIT 744
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3623
Mailing Address - Country:US
Mailing Address - Phone:864-363-8252
Mailing Address - Fax:
Practice Address - Street 1:900 W TRADE ST STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1144
Practice Address - Country:US
Practice Address - Phone:704-332-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139431223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health