Provider Demographics
NPI:1235418690
Name:MILLER, ALEXA ALLISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:ALLISON
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEXA
Other - Middle Name:ALLISON
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:143 POSTON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-6413
Mailing Address - Country:US
Mailing Address - Phone:931-268-2345
Mailing Address - Fax:
Practice Address - Street 1:103 EAST GORE AVE
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-0595
Practice Address - Country:US
Practice Address - Phone:931-268-9323
Practice Address - Fax:931-268-8618
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice