Provider Demographics
NPI:1386219848
Name:SARGENT, ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:SARGENT
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 1:10213 DUPONT CIRCLE DR W
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1656
Mailing Address - Country:US
Mailing Address - Phone:260-619-7044
Mailing Address - Fax:260-484-8706
Practice Address - Street 1:10213 DUPONT CIRCLE DR W
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1656
Practice Address - Country:US
Practice Address - Phone:260-619-7044
Practice Address - Fax:260-484-8706
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013620A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist