Healthcare Provider Details

I. General information

NPI: 1184000358
Provider Name (Legal Business Name): ALISA GEVORKYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 MING AVE
BAKERSFIELD CA
93309-5005
US

IV. Provider business mailing address

3990 MING AVE
BAKERSFIELD CA
93309-5005
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: