Provider Demographics
NPI:1629621610
Name:SMITH, ALEXAUNDREA (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXAUNDREA
Middle Name:
Last Name:SMITH
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 1:5831 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2715
Mailing Address - Country:US
Mailing Address - Phone:323-296-6180
Mailing Address - Fax:
Practice Address - Street 1:5831 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:WINDSOR HILLS
Practice Address - State:CA
Practice Address - Zip Code:90043-2715
Practice Address - Country:US
Practice Address - Phone:310-916-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7221122300000X
CA1066281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist