Provider Demographics
NPI:1174080576
Name:SOLLACCIO, ALEXIS A (DDS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:SOLLACCIO
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 1:235 LEES HILL RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-5503
Mailing Address - Country:US
Mailing Address - Phone:908-591-2084
Mailing Address - Fax:
Practice Address - Street 1:1806 SPRINGFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1005
Practice Address - Country:US
Practice Address - Phone:908-591-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020474001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice