Provider Demographics
NPI:1386205045
Name:DESILVA, ALEXIS GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:GRACE
Last Name:DESILVA
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 1:309 TUDOR ROSE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8681
Mailing Address - Country:US
Mailing Address - Phone:702-325-5738
Mailing Address - Fax:
Practice Address - Street 1:8275 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2543
Practice Address - Country:US
Practice Address - Phone:702-967-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist