Provider Demographics
NPI:1114306354
Name:GREGORY SHVARTSMAN DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:GREGORY SHVARTSMAN DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVARTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-909-7403
Mailing Address - Street 1:1711 VIA EL PRADO
Mailing Address - Street 2:STE 400B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5714
Mailing Address - Country:US
Mailing Address - Phone:310-792-8610
Mailing Address - Fax:
Practice Address - Street 1:1711 VIA EL PRADO
Practice Address - Street 2:STE 400B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5714
Practice Address - Country:US
Practice Address - Phone:310-792-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty