Healthcare Provider Details

I. General information

NPI: 1255986261
Provider Name (Legal Business Name): ALICIA MARIE HAZDOVAC YANOSIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA MARIE HAZDOVAC DDS

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26485 CARMEL RANCHO BLVD
CARMEL CA
93923-8706
US

IV. Provider business mailing address

3 FOREST KNOLL RD
MONTEREY CA
93940-5801
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-2111
  • Fax:
Mailing address:
  • Phone: 310-489-3907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: