=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265879902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELBY ALLISON ALEXANDER D.D.S., M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2013
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 451 SUNCREST TOWN CENTRE DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-293-5831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 PINNACLE HEIGHT DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-8067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-625-0961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4053
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------