Basic Information
Provider Information
NPI: 1518471788
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LING
FirstName: ALEXANDER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3631 SPENCER HWY
Address2:  
City: PASADENA
State: TX
PostalCode: 775041111
CountryCode: US
TelephoneNumber: 7139468999
FaxNumber:  
Practice Location
Address1: 3631 SPENCER HWY
Address2:  
City: PASADENA
State: TX
PostalCode: 775041111
CountryCode: US
TelephoneNumber: 7139468999
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/27/2017
LastUpdateDate: 08/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001XETN462TXN193400000X SINGLE SPECIALTY GROUPDental ProvidersDentistGeneral Practice
1223G0001X34521TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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