Provider Demographics
NPI:1053552562
Name:CALABASAS CENTER FOR ORAL SURGERY
Entity type:Organization
Organization Name:CALABASAS CENTER FOR ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXEI
Authorized Official - Middle Name:I
Authorized Official - Last Name:MIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-225-2211
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:818-225-7478
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:818-225-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty