Provider Demographics
NPI:1124401492
Name:PREVITI, ALEXA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:PREVITI
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 1:4095 ENGLISH CREEK AVE
Mailing Address - Street 2:UNITED STATES
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5742
Mailing Address - Country:US
Mailing Address - Phone:609-646-1989
Mailing Address - Fax:609-646-0052
Practice Address - Street 1:4095 ENGLISH CREEK AVE
Practice Address - Street 2:UNITED STATES
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5742
Practice Address - Country:US
Practice Address - Phone:609-646-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02594500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist