Provider Demographics
NPI:1083481931
Name:ALEX SADROSSADAT, DDS INC.
Entity Type:Organization
Organization Name:ALEX SADROSSADAT, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SADROSSADAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-334-4405
Mailing Address - Street 1:2080 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5768
Mailing Address - Country:US
Mailing Address - Phone:702-334-4405
Mailing Address - Fax:
Practice Address - Street 1:4545 E 3RD ST STE 108
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1656
Practice Address - Country:US
Practice Address - Phone:323-780-0189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental