Healthcare Provider Details

I. General information

NPI: 1114785896
Provider Name (Legal Business Name): ALEXIA DEDEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ASYLUM ST
MILFORD MA
01757-2203
US

IV. Provider business mailing address

88 WARREN ST
UPTON MA
01568-1595
US

V. Phone/Fax

Practice location:
  • Phone: 508-377-3868
  • Fax:
Mailing address:
  • Phone: 774-276-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10000914
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: