Provider Demographics
NPI:1689416646
Name:BERTRAND, ALEXANDERIA LYNNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDERIA
Middle Name:LYNNE
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 MCELVEY RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-4934
Mailing Address - Country:US
Mailing Address - Phone:906-236-4579
Mailing Address - Fax:
Practice Address - Street 1:17350 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-6039
Practice Address - Country:US
Practice Address - Phone:850-230-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist