Alexandra Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ALEXANDRA DENTAL LLC

Practice address

654 Valley Cub Dr
Alexandria, AL 36250-4200

Phone

(256) 847-1111

NPI assigned

Mar 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brant Haynie, DMD

Title

Dentist

Phone

(205) 467-0387

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Marshall Hartzog, DMD

  • General Practice Dentistry
  • Alexandria, AL
  • NPI 1710554878
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520294400000",
    "number": "1194227090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 VALLEY CUB DR",
            "city": "ALEXANDRIA",
            "state": "AL",
            "postal_code": "362504200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 VALLEY CUB DR",
            "city": "ALEXANDRIA",
            "state": "AL",
            "postal_code": "362504200",
            "telephone_number": "256-847-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDRA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-06",
        "last_updated": "2018-03-06",
        "status": "A",
        "authorized_official_last_name": "HAYNIE",
        "authorized_official_first_name": "BRANT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "205-467-0387",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171653",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Associated Chiropractic Clinic, Inc
• William Timothy Bowden
• Sumuthra Bowers, MS, EDS, LPC
• Ahmad Carmichael
• Claxton Group LLC

• Dental Clinic/Center in Alexandria, AL
• Providers in Alexandria, AL by specialty
• Dental Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.