Healthcare Provider Details

I. General information

NPI: 1871389924
Provider Name (Legal Business Name): ALEXA MARTIN DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR STE 215
BEVERLY HILLS CA
90210-4351
US

IV. Provider business mailing address

435 N BEDFORD DR STE 215
BEVERLY HILLS CA
90210-4351
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-4186
  • Fax:
Mailing address:
  • Phone: 310-200-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: LORI MICELI
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 914-777-9465