Healthcare Provider Details

I. General information

NPI: 1538332028
Provider Name (Legal Business Name): ALEX A. PEZESHKIAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 BALL RD STE 310
CYPRESS CA
90630-3966
US

IV. Provider business mailing address

6101 BALL ROAD. STE. #310
CYPRESS CA
90630
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-9486
  • Fax: 714-220-9481
Mailing address:
  • Phone: 714-220-9486
  • Fax: 714-220-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number34402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: