# ALEXANDER V. ANTIPOV, D.D.S., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114533064
- **Authorized official:** ALEXANDER ANTIPOV DDS (OWNER)
- **Authorized official phone:** (916) 783-2110

## Contact information

- **Practice address:** 911 RESERVE DRIVE, SUITE 150, ROSEVILLE, CA 95678
- **Practice address phone:** (916) 783-2110
- **Practice address fax:** (916) 783-2111
- **Mailing address:** 911 RESERVE DRIVE, SUITE 150, ROSEVILLE, CA 95678
- **Mailing address phone:** (916) 783-2110
- **Mailing address fax:** (916) 783-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2020
- **Last updated:** 09/16/2020