Healthcare Provider Details

I. General information

NPI: 1659298362
Provider Name (Legal Business Name): ALEXANDRA KALABAT SEMMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35046 WOODWARD AVE STE 200
BIRMINGHAM MI
48009-0964
US

IV. Provider business mailing address

2093 BURGUNDY ST
WEST BLOOMFIELD MI
48323-3023
US

V. Phone/Fax

Practice location:
  • Phone: 248-781-3220
  • Fax:
Mailing address:
  • Phone: 248-915-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901602434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: