Provider Demographics
NPI:1841225067
Name:HIMMELSTEIN, LOUIS HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:HENRY
Last Name:HIMMELSTEIN
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 1:135 KELLER STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2312
Mailing Address - Country:US
Mailing Address - Phone:707-763-0949
Mailing Address - Fax:707-763-8724
Practice Address - Street 1:135 KELLER STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2312
Practice Address - Country:US
Practice Address - Phone:707-763-0949
Practice Address - Fax:707-763-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice