Healthcare Provider Details

I. General information

NPI: 1215128343
Provider Name (Legal Business Name): ALLA ALEXIS SHRAGER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS SHRAGER DMD

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 BANDFORD WAY STE 105
RALEIGH NC
27615-2765
US

IV. Provider business mailing address

9012 MEADOW MIST CT
RALEIGH NC
27617-7478
US

V. Phone/Fax

Practice location:
  • Phone: 412-720-9277
  • Fax:
Mailing address:
  • Phone: 412-720-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 16446
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10475
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: