Provider Demographics
NPI:1770274532
Name:BALISTERRI, ALEXIS KATHRYN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:KATHRYN
Last Name:BALISTERRI
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 1:6800 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9400
Mailing Address - Country:US
Mailing Address - Phone:501-772-5006
Mailing Address - Fax:
Practice Address - Street 1:818 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4162
Practice Address - Country:US
Practice Address - Phone:501-776-0564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice