Provider Demographics
NPI:1720317456
Name:ALAY, RODERIK STEVEN (DA)
Entity Type:Individual
Prefix:
First Name:RODERIK
Middle Name:STEVEN
Last Name:ALAY
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2408
Mailing Address - Country:US
Mailing Address - Phone:310-792-5200
Mailing Address - Fax:310-792-5201
Practice Address - Street 1:3820 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2408
Practice Address - Country:US
Practice Address - Phone:310-792-5200
Practice Address - Fax:310-792-5201
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4481020126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant