Provider Demographics
NPI:1265291249
Name:ALEXANDER LEE DENTAL CORPORATION
Entity type:Organization
Organization Name:ALEXANDER LEE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAGALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-299-2525
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91386-1847
Mailing Address - Country:US
Mailing Address - Phone:661-299-2525
Mailing Address - Fax:
Practice Address - Street 1:18635 SOLEDAD CANYON RD STE 108
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3723
Practice Address - Country:US
Practice Address - Phone:661-299-2525
Practice Address - Fax:661-299-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty