Provider Demographics
NPI:1780989459
Name:KALMANOVICH, ALEXANDER (DDS, INC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KALMANOVICH
Suffix:
Gender:M
Credentials:DDS, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 PETIT AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1133
Mailing Address - Country:US
Mailing Address - Phone:818-730-9422
Mailing Address - Fax:
Practice Address - Street 1:380 GLENNEYRE ST STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2303
Practice Address - Country:US
Practice Address - Phone:949-494-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59717122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist