Provider Demographics
NPI:1023166725
Name:KHAIMOV, ALEXANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:KHAIMOV
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 1:8610 LEWIS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9597
Mailing Address - Country:US
Mailing Address - Phone:917-992-1066
Mailing Address - Fax:
Practice Address - Street 1:8610 LEWIS RIVER RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-9597
Practice Address - Country:US
Practice Address - Phone:917-992-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506661223G0001X
FLDN273691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02408982Medicaid