Basic Information
| Provider Information | |||||||||
| NPI: | 1083625792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARIFIAN | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13721 NEWPORT AVE | ||||||||
| Address2: | STE. 1 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927804690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143681400 | ||||||||
| FaxNumber: | 7143681411 | ||||||||
| Practice Location | |||||||||
| Address1: | 2860 MICHELLE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926061009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145083600 | ||||||||
| FaxNumber: | 7143682092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 11/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6274 | AZ | N | Dental Providers | Dentist | General Practice | 1223G0001X | 4908 | NV | N | Dental Providers | Dentist | General Practice | 1223G0001X | 2012027620 | MO | N | Dental Providers | Dentist | General Practice | 1223G0001X | 9057 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | 61076 | KS | N | Dental Providers | Dentist | General Practice | 1223G0001X | 0401415880 | VA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 44540 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.