Provider Demographics
NPI:1417149212
Name:MIZIN, ALEXEI I (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXEI
Middle Name:I
Last Name:MIZIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24013 VENTURA BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1447
Mailing Address - Country:US
Mailing Address - Phone:818-225-2211
Mailing Address - Fax:
Practice Address - Street 1:24013 VENTURA BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1447
Practice Address - Country:US
Practice Address - Phone:818-225-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery