Provider Demographics
NPI:1033992599
Name:ALLA ALEXIS SHRAGER DMD 4 PLLC
Entity Type:Organization
Organization Name:ALLA ALEXIS SHRAGER DMD 4 PLLC
Other - Org Name:SOUTHERN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:ALLA
Authorized Official - Last Name:SHRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-636-5200
Mailing Address - Street 1:8331 BANDFORD WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2765
Mailing Address - Country:US
Mailing Address - Phone:919-636-5200
Mailing Address - Fax:919-847-7391
Practice Address - Street 1:8331 BANDFORD WAY STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2765
Practice Address - Country:US
Practice Address - Phone:919-636-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12355OtherDENTAL