Provider Demographics
NPI:1265728646
Name:LAROSE, ALEXIS CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:CHRISTINE
Last Name:LAROSE
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 1:1420 LINCOLN WAY
Mailing Address - Street 2:#200
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-664-8283
Mailing Address - Fax:208-667-0794
Practice Address - Street 1:1420 LINCOLN WAY
Practice Address - Street 2:#200
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-664-8283
Practice Address - Fax:208-667-0794
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2459122300000X
IDD-44541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist