Healthcare Provider Details

I. General information

NPI: 1578174843
Provider Name (Legal Business Name): ALEXANDRA S GEORGE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 WEXFORD BAYNE RD STE 200
WEXFORD PA
15090-8900
US

IV. Provider business mailing address

181 WEXFORD BAYNE RD STE 200
WEXFORD PA
15090-8900
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3422
  • Fax: 724-934-3426
Mailing address:
  • Phone: 724-934-3422
  • Fax: 724-934-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDRA S GEORGE
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 724-934-3422