Provider Demographics
NPI:1487070306
Name:KANEVSKY, ALICE (DMD)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:KANEVSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 VALLEY HILL TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4620
Mailing Address - Country:US
Mailing Address - Phone:267-207-8137
Mailing Address - Fax:
Practice Address - Street 1:1611 PLUMMER STREET
Practice Address - Street 2:BLDG 10 RM 1C-100
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program