Provider Demographics
NPI:1992957567
Name:SHAYKOVA, ALEKSANDRA BLAGOEVA (DDS)
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:BLAGOEVA
Last Name:SHAYKOVA
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 1:710 WESTMOUNT DR
Mailing Address - Street 2:APT D
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5115
Mailing Address - Country:US
Mailing Address - Phone:310-657-8731
Mailing Address - Fax:
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3328
Practice Address - Country:US
Practice Address - Phone:310-289-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice