Individual
DR. ALEXANDER ALBERT JOSEPH JELICICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
188 LONGWOOD AVE, BOSTON, MA 02115-5819
(617) 432-1434
Mailing address
1365 BOYLSTON ST UNIT 1151, BOSTON, MA 02215-3919
(916) 605-9146
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1857626
MA
1223G0001X
General Practice Dentistry
DN1857626
MA
1223P0700X
Prosthodontics
Primary
DN1857626
MA
Other
Enumeration date
06/15/2017
Last updated
06/15/2017
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