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General NPI Number Information
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NPI Number | 1174443790
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Entity Type | Individual
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Provider Name | ALEXANDRA BONE
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Gender |
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 3440 OHIO ST
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City | GREAT LAKES
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State | IL
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Zip | 60088-3155
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Country | US
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Telephone | 224-610-8551
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Fax |
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Provider Business Mailing Address
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Address Line | 30027 N WAUKEGAN RD APT 116
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.037082
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License Number State | IL
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