Provider Demographics
NPI:1992056634
Name:GARLAND, ALEXANDRA (LD)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:GARLAND
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548
Mailing Address - Country:US
Mailing Address - Phone:360-426-8800
Mailing Address - Fax:
Practice Address - Street 1:114 W. ALDER STREET
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60186881122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist