Provider Demographics
NPI:1518583061
Name:MILLER, ALEXANDRA KAYE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:KAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:KAYE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15743 W RAIL DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7867
Mailing Address - Country:US
Mailing Address - Phone:812-249-4355
Mailing Address - Fax:
Practice Address - Street 1:893 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1782
Practice Address - Country:US
Practice Address - Phone:317-775-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-21
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016005851223G0001X
IN12014165A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty