Provider Demographics
NPI:1710464953
Name:SCHUTZ, ALEXANDRA MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:SCHUTZ
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 1:5443 PLATT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6203
Mailing Address - Country:US
Mailing Address - Phone:240-925-6493
Mailing Address - Fax:
Practice Address - Street 1:5443 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073
Practice Address - Country:US
Practice Address - Phone:803-470-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015722122300000X, 1223G0001X
SC94871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist