Provider Demographics
NPI:1831522119
Name:PANTZIS, ALEXANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:PANTZIS
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 1:16 E 52ND ST
Mailing Address - Street 2:1102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5306
Mailing Address - Country:US
Mailing Address - Phone:646-590-7525
Mailing Address - Fax:
Practice Address - Street 1:16 E 52ND ST
Practice Address - Street 2:1102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5306
Practice Address - Country:US
Practice Address - Phone:646-590-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist