Provider Demographics
NPI:1063677870
Name:MORADZADEH, ALEXANDER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:S
Last Name:MORADZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:S
Other - Last Name:MORADZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2206 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2049
Mailing Address - Country:US
Mailing Address - Phone:213-748-8448
Mailing Address - Fax:213-749-5569
Practice Address - Street 1:2206 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2049
Practice Address - Country:US
Practice Address - Phone:213-748-8448
Practice Address - Fax:213-749-5569
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA575061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program