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Provider Information for 1407340789

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALEXANDRA HABERSTROH DMD

Gender: FEMALE

Individual NPI: 1407340789

Calendar   Last Updated:  2018-06-19
  Certification Date: 

Details

Name Value
NPI 1407340789
Enumeration Date 2018-06-19
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 201 S EASTON RD
GLENSIDE, PA 19038-4403
United States

Phone: 215-237-1525 | Fax:
View Map External Link
Primary Practice Address 201 S EASTON RD
GLENSIDE, PA 19038-4403
United States

Phone: 215-237-1525 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice PA DS041729