Provider Demographics
NPI:1427292770
Name:DERIK ALEXANIANS DDS APC
Entity type:Organization
Organization Name:DERIK ALEXANIANS DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANIANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-632-5940
Mailing Address - Street 1:260 KEMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:818-242-4046
Mailing Address - Fax:818-244-6110
Practice Address - Street 1:520 E. BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205
Practice Address - Country:US
Practice Address - Phone:818-242-4046
Practice Address - Fax:818-244-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty