MEDICARE: ELIZABETH ALEXANDER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	11713	NC
2	122300000X	Dentist	DN1856296	MA
3	122300000X	Dentist	9246	SC

General Provider Information

NPI Number	:	1154761989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ALEXANDER D.M.D.

Provider Business Mailing Address
First Line	:	485 TOM HALL ST STE 106
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 TOM HALL ST STE 106
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2353
Country	:	US
Telephone Number	:	803-485-9333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	03/08/2023

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