Provider Demographics
NPI:1740516525
Name:ALEXIS-EDMOND, MITZ ANN (DDS)
Entity type:Individual
Prefix:MRS
First Name:MITZ
Middle Name:ANN
Last Name:ALEXIS-EDMOND
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 1:107 WEST 4TH STREET
Mailing Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CTR
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:
Practice Address - Street 1:107 WEST 4TH STREET
Practice Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CTR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice