Provider Demographics
NPI:1881361418
Name:MICHAEL SHAMTOUB DDS INC
Entity type:Organization
Organization Name:MICHAEL SHAMTOUB DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMTOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-387-6941
Mailing Address - Street 1:17205 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4007
Mailing Address - Country:US
Mailing Address - Phone:818-387-6941
Mailing Address - Fax:
Practice Address - Street 1:17205 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4007
Practice Address - Country:US
Practice Address - Phone:818-987-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty