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General NPI Number Information
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NPI Number | 1003801069
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Entity Type | Individual
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Provider Name | INNA V SHIMANOVSKY DMD
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Gender | Female
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16640 SE MCLOUGHLIN BLVD
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City | OAK GROVE
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State | OR
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Zip | 97267-4810
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Country | US
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Telephone | 503-659-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 13217 SW ROCKINGHAM DR
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City | TIGARD
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State | OR
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Zip | 97223-1779
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Country | US
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Telephone | 503-521-1946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7792
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License Number State | OR
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