Healthcare Provider Details

I. General information

NPI: 1730761917
Provider Name (Legal Business Name): ALEXANDER VAHDATI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 YORBA PL STE 210
PLACENTIA CA
92870-3108
US

IV. Provider business mailing address

11813 DARBY AVE
NORTHRIDGE CA
91326-1321
US

V. Phone/Fax

Practice location:
  • Phone: 714-524-0656
  • Fax:
Mailing address:
  • Phone: 818-515-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIN ALEXANDER
Title or Position: PRESIDENT
Credential: DMD,MSD,MRA
Phone: 818-515-2944