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General NPI Number Information
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NPI Number | 1972924090
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Entity Type | Organization
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Legal Business Name | AXELRODE ORTHODONTICS VALLEJO CALIFORNIA
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 15 ROTARY WAY
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City | VALLEJO
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State | CA
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Zip | 94591-8475
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Country | US
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Telephone | 707-643-2307
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ROTARY WAY
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City | VALLEJO
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State | CA
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Zip | 94591-8475
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Country | US
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Telephone | 707-643-2307
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC L AXELRODE
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Credential | DDS, MSD
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Telephone | 707-643-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 45640
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License Number State | CA
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