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General NPI Number Information
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NPI Number | 1083481931
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Entity Type | Organization
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Legal Business Name | ALEX SADROSSADAT, DDS INC.
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 4545 E 3RD ST STE 108
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City | LOS ANGELES
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State | CA
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Zip | 90022-1656
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Country | US
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Telephone | 323-780-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 GREENWOOD LN
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City | POMONA
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State | CA
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Zip | 91766-5768
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Country | US
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Telephone | 702-334-4405
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX SADROSSADAT
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Credential | DDS
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Telephone | 702-334-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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