Provider Demographics
NPI:1952903379
Name:POLCZYNSKI, ALEXIS ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:ROSE
Last Name:POLCZYNSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ROSE
Other - Last Name:LINTKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23522 WILDERNESS OAK STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23522 WILDERNESS OAK STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2409
Practice Address - Country:US
Practice Address - Phone:210-774-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3369641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty