Provider Demographics
NPI:1255463154
Name:SOLOVEYCHIK, ISABELLA SHTULMAN (DDS)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:SHTULMAN
Last Name:SOLOVEYCHIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:SHTULMAN -SOLOVEYCHIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5300 CYPRESS HAWK CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5009
Mailing Address - Country:US
Mailing Address - Phone:925-968-9004
Mailing Address - Fax:510-782-9944
Practice Address - Street 1:19682 HESPERIAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:510-782-9942
Practice Address - Fax:800-668-9530
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000007377OtherPACIFICARE DENTAL
CAB42228-01Medicaid
CA000000003937OtherUNITEDHEALTHCARE