Provider Demographics
NPI:1083307490
Name:ZUCKER, ALEXIS (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 E MAYO BLVD UNIT 1075
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4509
Mailing Address - Country:US
Mailing Address - Phone:480-888-6268
Mailing Address - Fax:
Practice Address - Street 1:18715 N REEMS RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8643
Practice Address - Country:US
Practice Address - Phone:623-975-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0117871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice