=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497010458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA MALEBRANCHE DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2012
-----------------------------------------------------
Last Update Date | 03/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 693 MAIN STREET BUILDING B, SUITE 1
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-845-3053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 349
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-0349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 98-453-0536
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DS040740
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------