Provider Demographics
NPI:1487277950
Name:JULIEN-DALTON, ALEXANDRA ELLYSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELLYSE
Last Name:JULIEN-DALTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BRITTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2400
Mailing Address - Country:US
Mailing Address - Phone:919-337-5910
Mailing Address - Fax:
Practice Address - Street 1:1108 BRITTLEY WAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2400
Practice Address - Country:US
Practice Address - Phone:919-337-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice