Provider Demographics
NPI:1649225061
Name:MAI, ALEXIS M (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:MAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 CLOUGH LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1708
Mailing Address - Country:US
Mailing Address - Phone:724-467-2236
Mailing Address - Fax:
Practice Address - Street 1:599 FREEDOM PARK DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5130
Practice Address - Country:US
Practice Address - Phone:859-426-0304
Practice Address - Fax:859-426-3684
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83271223G0001X
OH300222491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice