Provider Demographics
NPI:1992887590
Name:ALEXANIANS, DERIK (DDS)
Entity type:Individual
Prefix:MR
First Name:DERIK
Middle Name:
Last Name:ALEXANIANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 KEMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1320
Mailing Address - Country:US
Mailing Address - Phone:818-892-9600
Mailing Address - Fax:
Practice Address - Street 1:8940 WOODMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-8027
Practice Address - Country:US
Practice Address - Phone:818-892-9600
Practice Address - Fax:818-892-2209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice