Healthcare Provider Details

I. General information

NPI: 1063677870
Provider Name (Legal Business Name): ALEXANDER S MORADZADEH D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER S MORADZADEH D.D.S

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 S FIGUEROA ST
LOS ANGELES CA
90007-2049
US

IV. Provider business mailing address

2206 S FIGUEROA ST
LOS ANGELES CA
90007-2049
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-8448
  • Fax: 213-749-5569
Mailing address:
  • Phone: 213-748-8448
  • Fax: 213-749-5569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number57506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: