Healthcare Provider Details

I. General information

NPI: 1801011739
Provider Name (Legal Business Name): ALEXANDER VISOT I DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER VISOT DDS

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23111 VENTURA BLVD STE 104
WOODLAND HILLS CA
91364-1132
US

IV. Provider business mailing address

23111 VENTURA BLVD STE 104
WOODLAND HILLS CA
91364-1132
US

V. Phone/Fax

Practice location:
  • Phone: 818-225-7768
  • Fax:
Mailing address:
  • Phone: 818-225-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number43877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: