Provider Demographics
NPI:1013537604
Name:ALEX MAROSE DDS INC.
Entity Type:Organization
Organization Name:ALEX MAROSE DDS INC.
Other - Org Name:ALEX MAROSE DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-874-0025
Mailing Address - Street 1:1855 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1125
Mailing Address - Country:US
Mailing Address - Phone:626-699-6115
Mailing Address - Fax:
Practice Address - Street 1:1855 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1125
Practice Address - Country:US
Practice Address - Phone:626-699-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty