Individual
DR. ALEXANDRA GRIFFIN WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(843) 792-7365
Mailing address
1292 ASPEN WAY, MENDOTA HEIGHTS, MN 55118-1750
(651) 815-5678
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D14619
MN
1223P0221X
Pediatric Dentistry
Primary
DGD.10574
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2021
Last updated
02/25/2024
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