Provider Demographics
NPI:1083896203
Name:VIA DE VENTURA DENTAL CARE LLC
Entity type:Organization
Organization Name:VIA DE VENTURA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEPAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-948-4445
Mailing Address - Street 1:8600 E VIA DE VENTURA
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3323
Mailing Address - Country:US
Mailing Address - Phone:480-948-4445
Mailing Address - Fax:480-948-0082
Practice Address - Street 1:8600 E VIA DE VENTURA
Practice Address - Street 2:SUITE 202
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3323
Practice Address - Country:US
Practice Address - Phone:480-948-4445
Practice Address - Fax:480-948-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty