Healthcare Provider Details

I. General information

NPI: 1811424013
Provider Name (Legal Business Name): ALEXIS LEE GINNANE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GEIGER RD
PHILADELPHIA PA
19115-1008
US

IV. Provider business mailing address

1225 TREE ST
PHILADELPHIA PA
19148-2907
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-2411
  • Fax: 215-827-5136
Mailing address:
  • Phone: 610-739-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041250
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS041250
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: