Provider Demographics
NPI:1972649721
Name:MICHELMAN, ALEXIS BROOKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:BROOKE
Last Name:MICHELMAN
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 1:103 WILTSHIRE RD
Mailing Address - Street 2:APT D-13
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4559
Mailing Address - Country:US
Mailing Address - Phone:631-431-5481
Mailing Address - Fax:
Practice Address - Street 1:656 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1695
Practice Address - Country:US
Practice Address - Phone:631-225-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice