Provider Demographics
NPI:1932159019
Name:ALEEMUDDIN, PERVEEN (DDS)
Entity Type:Individual
Prefix:
First Name:PERVEEN
Middle Name:
Last Name:ALEEMUDDIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:PERVEEN
Other - Middle Name:
Other - Last Name:ALEEMUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5600
Mailing Address - Country:US
Mailing Address - Phone:714-579-7788
Mailing Address - Fax:714-579-7780
Practice Address - Street 1:155 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5600
Practice Address - Country:US
Practice Address - Phone:714-579-7788
Practice Address - Fax:714-579-7780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB42516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA516916Medicare ID - Type Unspecified