Provider Demographics
NPI:1740456250
Name:LICHT, ALAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:LICHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18372 CLARK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3550
Mailing Address - Country:US
Mailing Address - Phone:818-996-5100
Mailing Address - Fax:
Practice Address - Street 1:18372 CLARK ST STE 201
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3550
Practice Address - Country:US
Practice Address - Phone:818-996-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD213811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics