Provider Demographics
NPI:1275022949
Name:DOSTAL, ALEXA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:DOSTAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5619 S 204TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4285
Mailing Address - Country:US
Mailing Address - Phone:531-484-3050
Mailing Address - Fax:
Practice Address - Street 1:5619 S 204TH AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4285
Practice Address - Country:US
Practice Address - Phone:531-484-3050
Practice Address - Fax:531-484-4140
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty