Provider Demographics
NPI:1891145777
Name:PORCU, ALEXANDRA R (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:R
Last Name:PORCU
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 1:586 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5628
Mailing Address - Country:US
Mailing Address - Phone:518-587-8885
Mailing Address - Fax:518-587-2827
Practice Address - Street 1:8 MEDICAL ARTS LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1017
Practice Address - Country:US
Practice Address - Phone:518-401-0621
Practice Address - Fax:518-584-8720
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05936711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice