Provider Demographics
NPI:1275970279
Name:ALEX SHARIFIAN DDS PARKVILLE MODERN DENTISTRY, PC
Entity Type:Organization
Organization Name:ALEX SHARIFIAN DDS PARKVILLE MODERN DENTISTRY, PC
Other - Org Name:PARKVILLE MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHARIFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-746-1171
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:6340 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2473
Practice Address - Country:US
Practice Address - Phone:816-746-1171
Practice Address - Fax:816-746-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty