Provider Demographics
NPI:1215128343
Name:SHRAGER, ALLA ALEXIS (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:ALEXIS
Last Name:SHRAGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:SHRAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9012 MEADOW MIST CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7478
Mailing Address - Country:US
Mailing Address - Phone:412-720-9277
Mailing Address - Fax:
Practice Address - Street 1:8331 BANDFORD WAY STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2765
Practice Address - Country:US
Practice Address - Phone:412-720-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 164461223X0400X
NC104751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 16446OtherDEP OF HEALTH LICENSE