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General NPI Number Information
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NPI Number | 1780970012
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Entity Type | Organization
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Legal Business Name | ALEX EIDELSTEIN DDS & GUY LEVI DDS, A DENTAL CORPORATION
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 801 N TUSTIN AVE STE 708
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City | SANTA ANA
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State | CA
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Zip | 92705-3612
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Country | US
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Telephone | 714-285-0500
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Fax | 714-285-0501
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Provider Business Mailing Address
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Address Line | 10738 NATIONAL BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-4234
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Country | US
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Telephone | 310-425-8855
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Fax | 818-301-2331
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUY LEVI
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Credential | DDS
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Telephone | 310-866-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53240
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License Number State | CA
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