Provider Demographics
NPI:1770894149
Name:HALLISSEY, ALEXIS MARTHAJANE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARTHAJANE
Last Name:HALLISSEY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:MARTHAJANE
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1728
Mailing Address - Country:US
Mailing Address - Phone:207-439-2310
Mailing Address - Fax:
Practice Address - Street 1:1264 NEXTON PKWY STE 202
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2167
Practice Address - Country:US
Practice Address - Phone:854-237-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038581223G0001X
SC98401223G0001X
ME4412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30309908Medicaid