Healthcare Provider Details

I. General information

NPI: 1518514587
Provider Name (Legal Business Name): IRINA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

IV. Provider business mailing address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

V. Phone/Fax

Practice location:
  • Phone: 843-474-4051
  • Fax:
Mailing address:
  • Phone: 843-474-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4146
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: