Provider Demographics
NPI:1942753595
Name:ALEXANDRIAN DENTISTRY INC.
Entity Type:Organization
Organization Name:ALEXANDRIAN DENTISTRY INC.
Other - Org Name:KOOL DENTAL AND BRACES OF MONTEBELLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAREG
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:ALEXANDRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-640-5889
Mailing Address - Street 1:15643 SHERMAN WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4135
Mailing Address - Country:US
Mailing Address - Phone:323-721-4328
Mailing Address - Fax:323-721-3043
Practice Address - Street 1:235 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3776
Practice Address - Country:US
Practice Address - Phone:323-721-4328
Practice Address - Fax:323-721-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty