Provider Demographics
NPI:1710072103
Name:SHWARTZMAN, IAN (DDS)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:SHWARTZMAN
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 1:330 N D ST
Mailing Address - Street 2:SUITE #360
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1545
Mailing Address - Country:US
Mailing Address - Phone:909-475-5564
Mailing Address - Fax:
Practice Address - Street 1:330 N D ST
Practice Address - Street 2:SUITE# 360
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1545
Practice Address - Country:US
Practice Address - Phone:909-475-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92431-01OtherDENTI CAL