Provider Demographics
NPI:1093897563
Name:TAVERAS, ALEJANDRA ALBANIA (DDS)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:ALBANIA
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22218 GERMAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-0232
Mailing Address - Country:US
Mailing Address - Phone:818-370-7416
Mailing Address - Fax:
Practice Address - Street 1:22218 GERMAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-0232
Practice Address - Country:US
Practice Address - Phone:818-370-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist