Provider Demographics
NPI:1992481170
Name:EASON, ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:EASON
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 1:670 BOULEVARD DE FRANCE, MCRD PARRIS ISLAND, SC
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:29905-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4021 CANAL ST, JACKSONVILLE, NC 28540
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:517-614-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28014122300000X
FLDN28014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist