Provider Demographics
NPI:1184822462
Name:INNA SHTURMAN, D.D.S. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:INNA SHTURMAN, D.D.S. A PROFESSIONAL CORPORATION
Other - Org Name:THE SMILE DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-737-6453
Mailing Address - Street 1:3000 L ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5248
Mailing Address - Country:US
Mailing Address - Phone:916-737-6453
Mailing Address - Fax:916-737-3075
Practice Address - Street 1:3000 L ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5248
Practice Address - Country:US
Practice Address - Phone:916-737-6453
Practice Address - Fax:916-737-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45975OtherSTATE DENTAL LICENSE #
CA6319250001Medicare NSC