Provider Demographics
NPI:1003642489
Name:BOJRAB, ALEXANDRA (DDS, MSD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BOJRAB
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3622
Mailing Address - Country:US
Mailing Address - Phone:260-341-7451
Mailing Address - Fax:
Practice Address - Street 1:7007 US 31
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8686
Practice Address - Country:US
Practice Address - Phone:317-676-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013822A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics