Provider Demographics
NPI:1447268214
Name:GEORGE, ALEXANDRA STAKIAS (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:STAKIAS
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WEXFORD BAYNE RD
Mailing Address - Street 2:#200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8790
Mailing Address - Country:US
Mailing Address - Phone:724-934-3422
Mailing Address - Fax:724-934-3426
Practice Address - Street 1:171 WEXFORD BAYNE RD
Practice Address - Street 2:#200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8790
Practice Address - Country:US
Practice Address - Phone:724-934-3422
Practice Address - Fax:724-934-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO27351L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice