Healthcare Provider Details

I. General information

NPI: 1417401464
Provider Name (Legal Business Name): ALEXANDRIAN DENTISTRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7541 SEPULVEDA BLVD
VAN NUYS CA
91405-1645
US

IV. Provider business mailing address

15643 SHERMAN WAY SUITE. 220
VAN NUYS CA
91406-4135
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-9468
  • Fax: 818-891-1600
Mailing address:
  • Phone: 855-705-3434
  • Fax: 855-705-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NAREG OLIVER ALEXANDRIAN
Title or Position: OWNER
Credential: DDS
Phone: 818-640-5889