Individual provider Active NPI

Alexander V Marose

  • Dentist
  • Mission Viejo, CA
National Provider Identifier
1083966972
Registry record updated Nov 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
61710 Issued in CA
Practice address
25542 Jeronimo Rd Ste 3
Mission Viejo, CA 92691-2724
Phone
(949) 457-0223
Fax
(949) 588-2766
NPI assigned
Oct 3, 2012
Last updated
Nov 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61710 CA Primary

Addresses

Primary practice location

25542 Jeronimo Rd Ste 3
Mission Viejo, CA 92691-2724

Mailing address

25542 Jeronimo Rd Ste 3
Mission Viejo, CA 92691-2724
Phone (949) 874-0025

Other practice location 1

154 Plaza Dr
West Covina, CA 91790-2873
Phone (626) 962-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61710CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alex Marose DDS Inc. CurrentSince Apr 26, 2020 Accepting new patients
James N Vartanian, DDS Inc Dentist Current Accepting new patients
Dr a Winter a Profession Corporation Past Accepting new patients
Dental Excellence Inc. Dentist Past Accepting new patients

Locations

1855 N Hacienda Blvd
La Puente, CA 91744
Phone (626) 699-6115

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604188800000",
    "number": "1083966972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25542 JERONIMO RD STE 3",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912724",
            "telephone_number": "949-874-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25542 JERONIMO RD STE 3",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912724",
            "telephone_number": "949-457-0223",
            "fax_number": "949-588-2766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "154 Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917902873",
            "country_code": "US",
            "telephone_number": "626-962-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAROSE",
        "first_name": "ALEXANDER",
        "middle_name": "V",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-03",
        "last_updated": "2020-11-01",
        "certification_date": "2020-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.