Provider Demographics
NPI:1629141452
Name:MIERZWA, ALEXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:MIERZWA
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 1:181 HAMMACK LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-1602
Mailing Address - Country:US
Mailing Address - Phone:716-308-7030
Mailing Address - Fax:
Practice Address - Street 1:650 CEDAR CREEK GRADE
Practice Address - Street 2:SUITE 211
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6452
Practice Address - Country:US
Practice Address - Phone:540-486-5111
Practice Address - Fax:540-486-5112
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412114122300000X
NY052401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02738663Medicaid