Provider Demographics
NPI:1336535269
Name:ALEXANDER JAKE MORENO, DDS, INC.
Entity Type:Organization
Organization Name:ALEXANDER JAKE MORENO, DDS, INC.
Other - Org Name:VENTURA SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NENETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-658-0700
Mailing Address - Street 1:178 S VICTORIA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4369
Mailing Address - Country:US
Mailing Address - Phone:805-658-0700
Mailing Address - Fax:
Practice Address - Street 1:178 S VICTORIA AVE STE C
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4369
Practice Address - Country:US
Practice Address - Phone:805-658-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty