MEDICARE: DR. ALEKSANDR KLEBANER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	45582	CA

General Provider Information

NPI Number	:	1033217286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEKSANDR KLEBANER DDS

Provider Business Mailing Address
First Line	:	501 WALNUT ST
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-2321
Country	:	US
Telephone Number	:	650-592-3436
Fax Number	:	650-654-1847

Provider Business Practice Location Address
First Line	:	501 WALNUT ST
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-2321
Country	:	US
Telephone Number	:	650-592-3436
Fax Number	:	650-654-1847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/19/2015

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