Provider Demographics
NPI:1447989322
Name:GIANNOTTI, ALYSSA ALEXANDRIA (DDS)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ALEXANDRIA
Last Name:GIANNOTTI
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 1:22 BRAMHALL ST (P5A #5328)
Mailing Address - Street 2:MAINE MEDICAL CENTER
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-0111
Mailing Address - Fax:207-662-7066
Practice Address - Street 1:22 BRAMHALL ST (P5A #5328)
Practice Address - Street 2:MAINE MEDICAL CENTER
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-0111
Practice Address - Fax:207-662-7066
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-03-21
Deactivation Date:2023-03-03
Deactivation Code:
Reactivation Date:2023-03-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program