Provider Demographics
NPI:1811003049
Name:ALEXI KOSSI, DDS INC.
Entity Type:Organization
Organization Name:ALEXI KOSSI, DDS INC.
Other - Org Name:SMILE CITY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-702-9595
Mailing Address - Street 1:19366 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2629
Mailing Address - Country:US
Mailing Address - Phone:661-252-8888
Mailing Address - Fax:661-252-8808
Practice Address - Street 1:19366 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2629
Practice Address - Country:US
Practice Address - Phone:661-252-8888
Practice Address - Fax:661-252-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42659-01OtherDENTI-CAL
CAB42659-02OtherDENTI-CAL