MEDICARE: DR. MARINA ALEX SHNAYDMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	43246	CA

General Provider Information

NPI Number	:	1386703155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARINA ALEX SHNAYDMAN DDS

Provider Business Mailing Address
First Line	:	1718 8TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4707
Country	:	US
Telephone Number	:	415-987-2669
Fax Number	:	408-448-6443

Provider Business Practice Location Address
First Line	:	3535 ROSS AVE STE 207
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3039
Country	:	US
Telephone Number	:	408-269-3411
Fax Number	:	408-448-6443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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