Provider Demographics
NPI:1518852441
Name:MARTIN, ALEXANDRA CORINNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:CORINNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 HONORE AVE
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-5715
Mailing Address - Country:US
Mailing Address - Phone:708-925-4746
Mailing Address - Fax:
Practice Address - Street 1:2062 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4002
Practice Address - Country:US
Practice Address - Phone:773-384-3500
Practice Address - Fax:773-384-3963
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019036004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist