Provider Demographics
NPI:1568533776
Name:NAMIKAS, ALEXANDER G (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:G
Last Name:NAMIKAS
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 1:6032 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1126
Mailing Address - Country:US
Mailing Address - Phone:805-654-0930
Mailing Address - Fax:
Practice Address - Street 1:3555 LOMA VISTA RD
Practice Address - Street 2:SUITE 210
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-653-1776
Practice Address - Fax:805-653-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA276621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice