Provider Demographics
NPI:1477004224
Name:SHEINBAUM, JUSTIN MICHAEL (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:SHEINBAUM
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 GLENDON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4660
Mailing Address - Country:US
Mailing Address - Phone:954-803-0200
Mailing Address - Fax:
Practice Address - Street 1:10855 LECONTE AVE
Practice Address - Street 2:CHS A0-156
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90085
Practice Address - Country:US
Practice Address - Phone:310-825-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD55961223S0112X
CADDS1006991223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery