Provider Demographics
NPI:1558619783
Name:SHVARTSMAN, GREGORY IGOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:IGOR
Last Name:SHVARTSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 ARMOUR LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4819
Mailing Address - Country:US
Mailing Address - Phone:310-909-7403
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:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice