Aleksei Dolgov
Individual provider Active NPI General Practice Dentistry · Porter Ranch, CA
NPI 1902243454 · NPPES record last updated Aug 19, 2022
Key facts
- NPI
- 1902243454
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 107475 (CA)
- Practice address
- 11200 Corbin Ave # 208
Porter Ranch, CA 91326-4120 - Phone
- (614) 309-1050
- NPI assigned
- May 23, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150722005657 | OH | Order and Referring Only - Dentist |
0244543015 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107475 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aleksei Dolgov DDS Inc | Current |
Accepting new patients |
Locations
11200 Corbin Ave
Ste 208
Porter Ranch, CA 91326
Phone (614) 309-1050
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 107475 | CA | Yes |
Addresses
Primary practice location
11200 Corbin Ave # 208
Porter Ranch, CA 91326-4120
Mailing address
11200 Corbin Ave # 208
Porter Ranch, CA 91326-4120
Phone (614) 309-1050
Other providers in Porter Ranch, CA
- Madison Dennis
- Anna Anushik Derderian
- Nicole Sophia Dersahakian
- Adam Gemmel Reid Dietz
- Carol Dieu
- Katherine Duque
- Easy Sleep Solutions
- Eco Safe Transport Inc
- Naomi Miriam Ellison
- Michelle Lin Emi
All providers in Porter Ranch, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.