Provider Demographics
NPI:1982051033
Name:PATIL, ALEXANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:UNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:50 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3217
Mailing Address - Country:US
Mailing Address - Phone:910-347-5151
Mailing Address - Fax:
Practice Address - Street 1:50 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-347-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13651122300000X
VA0401415483122300000X
NC11001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist