Healthcare Provider Details

I. General information

NPI: 1760300958
Provider Name (Legal Business Name): ALAN DO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E ANAHEIM ST STE C
LONG BEACH CA
90813-3291
US

IV. Provider business mailing address

324 E ANAHEIM ST STE C
LONG BEACH CA
90813-3291
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-8100
  • Fax: 562-435-8128
Mailing address:
  • Phone: 562-435-8100
  • Fax: 562-435-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: