Provider Demographics
NPI:1053710517
Name:REIZIAN, ALEXANDROS MIHALIS (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDROS
Middle Name:MIHALIS
Last Name:REIZIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3202
Mailing Address - Country:US
Mailing Address - Phone:619-284-1197
Mailing Address - Fax:619-393-0182
Practice Address - Street 1:4711 MONROE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3202
Practice Address - Country:US
Practice Address - Phone:619-284-1197
Practice Address - Fax:619-393-0182
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64496122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist