Healthcare Provider Details

I. General information

NPI: 1659206738
Provider Name (Legal Business Name): ALEXIS CAVALIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W502 STATE ROAD 29
SPRING VALLEY WI
54767-9031
US

IV. Provider business mailing address

735 CROSBY DR
HUDSON WI
54016-7870
US

V. Phone/Fax

Practice location:
  • Phone: 715-778-5543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002149-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: