Provider Demographics
NPI:1912151838
Name:ALEXANDER, KEISHA N (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:N
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 SPRING LAKE SQ
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-291-4500
Mailing Address - Fax:863-299-3781
Practice Address - Street 1:1074 SPRING LAKE SQ
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-291-4500
Practice Address - Fax:863-299-3781
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 183621223X0400X
NC84601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics