Healthcare Provider Details

I. General information

NPI: 1003642489
Provider Name (Legal Business Name): ALEXANDRA BOJRAB DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 US 31
INDIANAPOLIS IN
46227-8686
US

IV. Provider business mailing address

222 BLUE RIDGE RD
INDIANAPOLIS IN
46208-3622
US

V. Phone/Fax

Practice location:
  • Phone: 317-676-3065
  • Fax:
Mailing address:
  • Phone: 260-341-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013822A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: