Provider Demographics
NPI:1801011739
Name:VISOT, ALEXANDER I (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:VISOT
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:VISOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:23111 VENTURA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1132
Mailing Address - Country:US
Mailing Address - Phone:818-225-7768
Mailing Address - Fax:
Practice Address - Street 1:23111 VENTURA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1132
Practice Address - Country:US
Practice Address - Phone:818-225-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery