Provider Demographics
NPI:1235280025
Name:URDANETA, ALEJANDRO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:JOSE
Last Name:URDANETA
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 1:9 ST STEVEN CT
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1081
Mailing Address - Country:US
Mailing Address - Phone:925-818-4592
Mailing Address - Fax:
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 5C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:UM
Practice Address - Phone:949-830-3731
Practice Address - Fax:949-830-7935
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492331223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice