Basic Information
| Provider Information | |||||||||
| NPI: | 1144209073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEITCH | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | KARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JARRETT WHITE ROAD | ||||||||
| Address2: | PRDC, USA DENTAC HAWAII CREDENTIALS OFFICE | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 JARRETT WHITE ROAD | ||||||||
| Address2: | PRDC, USA DENTAC HAWAII CREDENTIALS OFFICE | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | DE00009035 | WA | Y | Dental Providers | Dentist | Endodontics | 1223E0200X | 40927 | CA | N | Dental Providers | Dentist | Endodontics |
No ID Information.