Provider Demographics
NPI:1659158343
Name:ALEXANDER, ERICA WYNISHA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:WYNISHA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:WYNISHA
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:223 N ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1222
Mailing Address - Country:US
Mailing Address - Phone:267-266-2899
Mailing Address - Fax:
Practice Address - Street 1:2144 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4014
Practice Address - Country:US
Practice Address - Phone:215-320-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH075427124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist