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General NPI Number Information
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NPI Number | 1750553889
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Entity Type | Individual
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Provider Name | ALEXANDER ANTIPOV DDS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 911 RESERVE DRIVE SUITE 150
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City | ROSEVILLE
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State | CA
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Zip | 95678-1383
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Country | US
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Telephone | 916-783-2110
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Fax | 916-783-2111
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Provider Business Mailing Address
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Address Line | 911 RESERVE DR SUITE 150
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City | ROSEVILLE
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State | CA
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Zip | 95678-1340
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Country | US
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Telephone | 916-783-2110
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Fax | 916-783-2111
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 50724
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License Number State | CA
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