Provider Demographics
NPI:1154453470
Name:BORIS SHNAYDER DDS. A PROF. BUSINESS CORP.
Entity Type:Organization
Organization Name:BORIS SHNAYDER DDS. A PROF. BUSINESS CORP.
Other - Org Name:PARADISE SMILE DENTAL.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHNAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-257-9909
Mailing Address - Street 1:29491 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-2902
Mailing Address - Country:US
Mailing Address - Phone:661-257-9909
Mailing Address - Fax:661-257-0008
Practice Address - Street 1:29491 THE OLD RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-2902
Practice Address - Country:US
Practice Address - Phone:661-257-9909
Practice Address - Fax:661-257-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty