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General NPI Number Information
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NPI Number | 1912151838
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Entity Type | Individual
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Provider Name | KEISHA N ALEXANDER D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 1074 SPRING LAKE SQ
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City | WINTER HAVEN
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State | FL
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Zip | 33881
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Country | US
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Telephone | 863-291-4500
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Fax | 863-299-3781
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Provider Business Mailing Address
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Address Line | 1074 SPRING LAKE SQ
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City | WINTER HAVEN
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State | FL
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Zip | 33881
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Country | US
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Telephone | 863-291-4500
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Fax | 863-299-3781
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 18362
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8460
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License Number State | NC
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