Provider Demographics
NPI:1477123479
Name:CRETE, ALEXA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:CRETE
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 1:1000 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-5617
Mailing Address - Country:US
Mailing Address - Phone:970-775-4348
Mailing Address - Fax:
Practice Address - Street 1:1343 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1115
Practice Address - Country:US
Practice Address - Phone:970-484-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist