Provider Demographics
NPI:1740910017
Name:CHAMBERLAIN-UMANOFF, ALEXANDRA MASCARO (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MASCARO
Last Name:CHAMBERLAIN-UMANOFF
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:MASCARO
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1835 NEWPORT BLVD.
Mailing Address - Street 2:A109 PMB 252
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5031
Mailing Address - Country:US
Mailing Address - Phone:909-856-9748
Mailing Address - Fax:
Practice Address - Street 1:232 CAJON ST STE D
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5216
Practice Address - Country:US
Practice Address - Phone:909-793-2791
Practice Address - Fax:909-793-9701
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics