Provider Demographics
NPI:1669865721
Name:ALEXIEV, ELENA B (DMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:B
Last Name:ALEXIEV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ELENA
Other - Middle Name:B
Other - Last Name:GAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6766 WILLOW LAKE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966
Mailing Address - Country:US
Mailing Address - Phone:941-268-8391
Mailing Address - Fax:
Practice Address - Street 1:18070 S. TAMIAMI TRAIL
Practice Address - Street 2:#101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-236-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203330122300000X
FLDN216971223G0001X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program