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General NPI Number Information
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NPI Number | 1538332028
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Entity Type | Individual
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Provider Name | ALEX A. PEZESHKIAN DMD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 6101 BALL RD STE 310
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City | CYPRESS
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State | CA
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Zip | 90630-3966
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Country | US
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Telephone | 714-220-9486
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Fax | 714-220-9481
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Provider Business Mailing Address
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Address Line | 6101 BALL ROAD. STE. #310
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City | CYPRESS
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State | CA
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Zip | 90630
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Country | US
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Telephone | 714-220-9486
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Fax | 714-220-9481
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 34402
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License Number State | CA
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