Provider Demographics
NPI:1316075658
Name:MOJICA-GERRANS, ALEXANDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:MOJICA-GERRANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:MOJICA
Other - Last Name:GERRANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:287 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1413
Practice Address - Country:US
Practice Address - Phone:978-685-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice