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General NPI Number Information
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NPI Number | 1962839795
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Entity Type | Organization
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Legal Business Name | ALEXANDER GERBAKHER DMD CORP
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Dates
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Enumeration Date | 10/12/2013
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Last Update Date | 10/12/2013
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Provider Practice Location Address
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Address Line | 12135 MAGNOLIA BLVD
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2609
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Country | US
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Telephone | 818-761-0001
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Fax | 866-365-9764
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Provider Business Mailing Address
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Address Line | 12135 MAGNOLIA BLVD
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2609
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Country | US
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Telephone | 818-761-0001
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Fax | 866-365-9764
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER I GERBAKHER
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Credential | DMD
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Telephone | 818-761-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44175
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License Number State | CA
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