Provider Demographics
NPI:1588635072
Name:ROYZENBLAT, ALEXANDER
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ROYZENBLAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HENPHIL FARMS CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8199
Mailing Address - Country:US
Mailing Address - Phone:760-613-3917
Mailing Address - Fax:
Practice Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Practice Address - Street 2:SEWELL'S POINT BRANCH MEDICAL CLINIC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2802
Practice Address - Country:US
Practice Address - Phone:760-613-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2014-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4278122300000X
MI29010182111223G0001X
WI6495-151223E0200X
IL019028225122300000X
CA49796122300000X
VA04014143651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice