Healthcare Provider Details

I. General information

NPI: 1649507187
Provider Name (Legal Business Name): ALEXANDRA MITELMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 ROUTE 113
SOUDERTON PA
18964-1004
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 215-799-0241
  • Fax:
Mailing address:
  • Phone: 215-525-0105
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038071
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: