Healthcare Provider Details

I. General information

NPI: 1154453470
Provider Name (Legal Business Name): BORIS SHNAYDER DDS. A PROF. BUSINESS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29491 THE OLD RD
CASTAIC CA
91384-2902
US

IV. Provider business mailing address

29491 THE OLD RD
CASTAIC CA
91384-2902
US

V. Phone/Fax

Practice location:
  • Phone: 661-257-9909
  • Fax: 661-257-0008
Mailing address:
  • Phone: 661-257-9909
  • Fax: 661-257-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51376
License Number StateCA

VIII. Authorized Official

Name: DR. BORIS SHNAYDER
Title or Position: DENTIST
Credential: DDS
Phone: 661-257-9909