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General NPI Number Information
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NPI Number | 1770894149
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Entity Type | Individual
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Provider Name | ALEXIS MARTHAJANE HALLISSEY D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1264 NEXTON PKWY STE 202
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City | SUMMERVILLE
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State | SC
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Zip | 29486-2167
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Country | US
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Telephone | 854-237-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 23 WALKER ST
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City | KITTERY
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State | ME
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Zip | 03904-1728
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Country | US
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Telephone | 207-439-2310
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 03858
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9840
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4412
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License Number State | ME
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