Provider Demographics
NPI:1720425903
Name:PERI, ALEXANDRA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MICHELLE
Last Name:PERI
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 1:31182 CLAYMORE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1408
Mailing Address - Country:US
Mailing Address - Phone:248-310-4221
Mailing Address - Fax:
Practice Address - Street 1:44004 WOODWARD AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5032
Practice Address - Country:US
Practice Address - Phone:248-334-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist