Provider Demographics
NPI:1942202098
Name:AVANESSIAN, ALEX B (DDS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:B
Last Name:AVANESSIAN
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 1:7334 GIRARD AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5141
Mailing Address - Country:US
Mailing Address - Phone:858-459-0858
Mailing Address - Fax:858-459-0878
Practice Address - Street 1:7334 GIRARD AVE
Practice Address - Street 2:STE 204
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5141
Practice Address - Country:US
Practice Address - Phone:858-459-0858
Practice Address - Fax:858-459-0878
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics