Healthcare Provider Details

I. General information

NPI: 1225607104
Provider Name (Legal Business Name): ALEXANDRIA SPENCER FLORA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

211 S PLEASANT ST APT 4
ROYAL OAK MI
48067-2462
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6700
  • Fax:
Mailing address:
  • Phone: 317-750-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204801
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2951000998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: