Healthcare Provider Details

I. General information

NPI: 1992887590
Provider Name (Legal Business Name): DERIK ALEXANIANS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 WOODMAN AVE STE B
ARLETA CA
91331-8027
US

IV. Provider business mailing address

260 KEMPTON RD
GLENDALE CA
91202-1320
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-9600
  • Fax: 818-892-2209
Mailing address:
  • Phone: 818-892-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: