Provider Demographics
NPI:1326327263
Name:MANN, ALEXANDRA CINTHIA (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CINTHIA
Last Name:MANN
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 1:25 HENLEY ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2157
Mailing Address - Country:US
Mailing Address - Phone:207-653-8280
Mailing Address - Fax:
Practice Address - Street 1:171 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2310
Practice Address - Country:US
Practice Address - Phone:207-775-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist