NPIMap

Organization Active NPI

Alex Gladkov a Professional Dental Corporation

  • General Practice Dentistry
  • Santa Ana, CA
National Provider Identifier
1831414119
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
40822 Issued in CA
Legal business name
ALEX GLADKOV A PROFESSIONAL DENTAL CORPORATION
Practice address
1920 E 17TH St
Suite 100
Santa Ana, CA 92705-8626
Phone
(714) 953-6881
Fax
(714) 558-8618
NPI assigned
Mar 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Authorized official

Name
Alexander Gregory Gladkov, DDS
Title
Owner
Phone
(714) 953-6881

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 40822 CA Primary

Addresses

Primary practice location

1920 E 17TH St
Suite 100
Santa Ana, CA 92705-8626

Mailing address

1920 E 17TH St
Suite 100
Santa Ana, CA 92705-8626
Phone (714) 953-6881

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269907200000",
    "number": "1831414119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 E 17TH ST",
            "address_2": "SUITE 100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927058626",
            "telephone_number": "714-953-6881",
            "fax_number": "714-558-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 E 17TH ST",
            "address_2": "SUITE 100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927058626",
            "telephone_number": "714-953-6881",
            "fax_number": "714-558-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEX GLADKOV A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-30",
        "last_updated": "2010-03-30",
        "status": "A",
        "authorized_official_last_name": "GLADKOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-953-6881",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; 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.