Provider Demographics
NPI:1578651121
Name:ALEXIS-JOHNSON, CHUKYM COSSETTE (DDS)
Entity Type:Individual
Prefix:
First Name:CHUKYM
Middle Name:COSSETTE
Last Name:ALEXIS-JOHNSON
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 1:1101 BUNN HILL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5429
Mailing Address - Country:US
Mailing Address - Phone:607-797-5400
Mailing Address - Fax:
Practice Address - Street 1:1101 BUNN HILL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-5429
Practice Address - Country:US
Practice Address - Phone:607-797-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050949-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist