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General NPI Number Information
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NPI Number | 1780989459
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Entity Type | Individual
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Provider Name | ALEXANDER KALMANOVICH D.D.S., INC.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 380 GLENNEYRE ST STE E
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2303
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Country | US
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Telephone | 949-494-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 PETIT AVE
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City | ENCINO
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State | CA
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Zip | 91436-1133
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Country | US
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Telephone | 818-730-9422
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 59717
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License Number State | CA
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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 | 59717
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License Number State | CA
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