Provider Demographics
NPI:1114533064
Name:ALEXANDER V. ANTIPOV, D.D.S., INC.
Entity Type:Organization
Organization Name:ALEXANDER V. ANTIPOV, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIPOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-783-2110
Mailing Address - Street 1:911 RESERVE DRIVE, SUITE 150
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:916-783-2110
Mailing Address - Fax:916-783-2111
Practice Address - Street 1:911 RESERVE DRIVE, SUITE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-783-2110
Practice Address - Fax:916-783-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty