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General NPI Number Information
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NPI Number | 1194812974
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Entity Type | Individual
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Provider Name | ALEXANDER SERGEY LITVINOV DDS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-707-2863
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Fax | 856-662-2279
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Provider Business Mailing Address
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Address Line | 3223 N BROAD ST RM 3B03
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 217-707-2863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22DI02212900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI022129
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DS043891
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License Number State | PA
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