Provider Demographics
NPI:1164589040
Name:EIDELSTEIN, ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:EIDELSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23166 LOS ALISOS BLVD
Mailing Address - Street 2:SUITE #230
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2835
Mailing Address - Country:US
Mailing Address - Phone:949-457-0223
Mailing Address - Fax:949-588-2766
Practice Address - Street 1:23166 LOS ALISOS BLVD
Practice Address - Street 2:SUITE #230
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2835
Practice Address - Country:US
Practice Address - Phone:949-457-0223
Practice Address - Fax:949-588-2766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADH354901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice