Provider Demographics
NPI:1083625792
Name:SHARIFIAN, ALEX R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:R
Last Name:SHARIFIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13721 NEWPORT AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4690
Mailing Address - Country:US
Mailing Address - Phone:714-368-1400
Mailing Address - Fax:714-368-1411
Practice Address - Street 1:2860 MICHELLE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1009
Practice Address - Country:US
Practice Address - Phone:714-508-3600
Practice Address - Fax:714-368-2092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ62741223G0001X
NV49081223G0001X
MO20120276201223G0001X
SC90571223G0001X
KS610761223G0001X
VA04014158801223G0001X
CA445401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice