Healthcare Provider Details

I. General information

NPI: 1104210277
Provider Name (Legal Business Name): ALEXANDRA CLAIRE KORTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 W FOND DU LAC AVE
MILWAUKEE WI
53216-1382
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-445-6500
  • Fax: 414-445-6618
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1001970-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: