Provider Demographics
NPI:1730665241
Name:HUSSAR, ALEXANDRA ROCHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ROCHELLE
Last Name:HUSSAR
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 1:12597 W EDNA CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1953
Mailing Address - Country:US
Mailing Address - Phone:610-451-5297
Mailing Address - Fax:
Practice Address - Street 1:2275 S EAGLE RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2620
Practice Address - Country:US
Practice Address - Phone:208-215-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist