Provider Demographics
NPI:1386751097
Name:ALEXI KOSSI, PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ALEXI KOSSI, PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISARA
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:SWINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-702-9595
Mailing Address - Street 1:23884 COPPER HILL DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1701
Mailing Address - Country:US
Mailing Address - Phone:661-702-9595
Mailing Address - Fax:661-702-9919
Practice Address - Street 1:23884 COPPER HILL DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1701
Practice Address - Country:US
Practice Address - Phone:661-702-9595
Practice Address - Fax:661-702-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty