Provider Demographics
NPI:1083966972
Name:MAROSE, ALEXANDER V
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:V
Last Name:MAROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25542 JERONIMO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2724
Mailing Address - Country:US
Mailing Address - Phone:949-874-0025
Mailing Address - Fax:
Practice Address - Street 1:25542 JERONIMO RD STE 3
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2724
Practice Address - Country:US
Practice Address - Phone:949-457-0223
Practice Address - Fax:949-588-2766
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist