Provider Demographics
NPI:1093353401
Name:MARINA MILSTEIN DDS INC
Entity Type:Organization
Organization Name:MARINA MILSTEIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MILSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-677-1216
Mailing Address - Street 1:7095 DOUGLAS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6299
Mailing Address - Country:US
Mailing Address - Phone:916-677-1216
Mailing Address - Fax:
Practice Address - Street 1:7095 DOUGLAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6299
Practice Address - Country:US
Practice Address - Phone:916-677-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARINA MILSTEIN DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-16
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty