Provider Demographics
NPI:1053666065
Name:BOTERO, ALEXANDRA L (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:BOTERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13936 SW 102ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6611
Mailing Address - Country:US
Mailing Address - Phone:305-283-7772
Mailing Address - Fax:
Practice Address - Street 1:7902 NW 36TH ST STE 209
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6663
Practice Address - Country:US
Practice Address - Phone:305-402-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD20575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist