Alexa Brady Ellingsen Roehrig, DDS

Key facts

NPI: 1962992834
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 060673-01 (NY)
Practice address: 3425 Erie Blvd E
De Witt, NY 13214-1635
Phone: (315) 445-9400
NPI assigned: May 15, 2018
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Jose M Alvarez DDS PLLC General Practice Dentistry · Cicero, NY · NPI 1790447712

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
060673-01	NY	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Jose M Alvarez DDS PLLC	General Practice	Past since Oct 10, 2021	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
General Practice Dentistry	1223G0001X	060673-01	NY	Yes

Addresses

Primary practice location

3425 Erie Blvd E
De Witt, NY 13214-1635

Mailing address

1509 W Pinehill Rd
Spokane, WA 99218-2946
Phone (509) 389-6769

Other practice location 1

8057 Brewerton Rd
Cicero, NY 13039-9585
Phone (315) 698-0040

Other practice location 2

4001 N Cook St
Spokane, WA 99207-5879
Phone (509) 326-4343

Other names

Dr. Alexa Brady Ellingsen Former name

Other providers in De Witt, NY

Susan E Davoli, M.S.,CCC-SLP
Wendy Decker, P.T.
Elizabeth Defreitas, PHARMD
Scott Codwise Dickinson
Olesya Alexis Dmytryk, PMHNP-BC
John F Fatti, M.D.
Fitness Forum Physical and Occupational Therapy, PLLC
Judith K Flint, LCSW-R
Lawrence P Golding, DDS
Julie Hartenstein, P.T.

All providers in De Witt, NY · General Practice Dentistry in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.