Provider Demographics
NPI:1053750133
Name:BOUDAIE, ALEX (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BOUDAIE
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 1:11955 W WASHINGTON BLVD, SUITE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-237-5747
Mailing Address - Fax:310-237-5988
Practice Address - Street 1:11955 W WASHINGTON BLVD, SUITE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-237-5747
Practice Address - Fax:310-237-5988
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist