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General NPI Number Information
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NPI Number | 1053784553
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Entity Type | Organization
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Legal Business Name | ALEXANDER FAYNGOR DENTAL CORP.
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 6416 SANTA FE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 323-588-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 6416 SANTA FE AVE
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City | HUNTINGODN PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 323-588-6480
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Fax | 323-312-6373
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDER N. FAYNGOR
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Credential | D.D.S.
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Telephone | 323-588-6480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | CA
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