Provider Demographics
NPI:1972790756
Name:ALEXANDER, JORELLE REGINA (DMD,MPH)
Entity type:Individual
Prefix:DR
First Name:JORELLE
Middle Name:REGINA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 717
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-829-4208
Mailing Address - Fax:312-829-0987
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 717
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-829-4208
Practice Address - Fax:312-829-0987
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018001634122300000X
IL019027854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist