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General NPI Number Information
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NPI Number | 1205129624
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Entity Type | Organization
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Legal Business Name | DR.'S SHTURMAN, MICHELSON AND KISILYUK A DENTAL CORPORATION
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 1050 NORTHGATE DR 250B
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2526
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Country | US
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Telephone | 415-306-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 NORTHGATE DR 250B
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2526
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Country | US
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Telephone | 415-306-1456
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. CHRISTINE CAMPBELL
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Credential |
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Telephone | 916-737-6453
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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 | 45975
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License Number State | CA
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