Provider Demographics
NPI:1194196436
Name:ALEX G. GLADKOV DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALEX G. GLADKOV DENTAL CORPORATION
Other - Org Name:ORTHODONTIC CENTER OF ORANGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:G
Authorized Official - Last Name:GLADKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-972-9222
Mailing Address - Street 1:1920 E 17TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8626
Mailing Address - Country:US
Mailing Address - Phone:714-972-9222
Mailing Address - Fax:714-558-8618
Practice Address - Street 1:1920 E 17TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8626
Practice Address - Country:US
Practice Address - Phone:714-972-9222
Practice Address - Fax:714-558-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty