Provider Demographics
NPI:1508158742
Name:GLICKMAN, ALEXANDRA G (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:GLICKMAN
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 1:8940 N KENDALL DR
Mailing Address - Street 2:SUITE 604E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-595-1905
Mailing Address - Fax:305-595-2219
Practice Address - Street 1:521 N 11TH ST FL 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5016
Practice Address - Country:US
Practice Address - Phone:804-628-6637
Practice Address - Fax:804-827-1040
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0584371223S0112X
FLDN210841223S0112X
390200000X
VA04014181361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program