MEDICARE: ALEX SHARIFIAN DDS LINDENWOOD DENTISTRY, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518412527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX SHARIFIAN DDS LINDENWOOD DENTISTRY, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	2048 1ST CAPITOL DRIVE
Second Line	:
City	:	ST. CHARLES
State	:	MO
Zip	:	63301
Country	:	US
Telephone Number	:	636-345-9245
Fax Number	:	636-389-5002

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEX R SHARIFIAN
Credential	:	DDS
Telephone Number	:	636-345-9245

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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