Provider Demographics
NPI:1609364009
Name:HYLEN, ALEXANDRA K (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:K
Last Name:HYLEN
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 1:4489 BYRON CENTER AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4804
Mailing Address - Country:US
Mailing Address - Phone:616-534-8554
Mailing Address - Fax:616-534-8063
Practice Address - Street 1:4489 BYRON CENTER AVE SW STE A
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-534-8554
Practice Address - Fax:616-534-8063
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016001461223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program