Provider Demographics
NPI:1609636687
Name:AMILIEN, ALEXIS CHRISTIAN HENRI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:CHRISTIAN HENRI
Last Name:AMILIEN
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 1:8910 ACTIVITY RD STE J
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4459
Mailing Address - Country:US
Mailing Address - Phone:619-920-3950
Mailing Address - Fax:
Practice Address - Street 1:3403 E PLAZA BLVD STE F
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4140
Practice Address - Country:US
Practice Address - Phone:619-267-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist