MEDICARE: ALEX SADROSSADAT, DDS INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1083481931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX SADROSSADAT, DDS INC.

Provider Business Mailing Address
First Line	:	2080 GREENWOOD LN
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-5768
Country	:	US
Telephone Number	:	702-334-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 E 3RD ST STE 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1656
Country	:	US
Telephone Number	:	323-780-0189
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEX SADROSSADAT
Credential	:	DDS
Telephone Number	:	702-334-4405

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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