Provider Demographics
NPI:1306214309
Name:ARDITTI, ALEXANDRIA NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:ARDITTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:NICOLE
Other - Last Name:GRABOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15921 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3127
Mailing Address - Country:US
Mailing Address - Phone:909-499-0713
Mailing Address - Fax:
Practice Address - Street 1:15921 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3127
Practice Address - Country:US
Practice Address - Phone:909-499-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist