Provider Demographics
NPI:1376380899
Name:ERIC L. AXELRODE, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ERIC L. AXELRODE, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAVATTUVEETIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-306-7576
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:916-306-7576
Mailing Address - Fax:
Practice Address - Street 1:1016 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1924
Practice Address - Country:US
Practice Address - Phone:925-376-2800
Practice Address - Fax:925-376-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty