Provider Demographics
NPI:1144993502
Name:SHVARTSMAN SHIMADA DENTAL PARTNERSHIP
Entity type:Organization
Organization Name:SHVARTSMAN SHIMADA DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIMADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-792-8610
Mailing Address - Street 1:1711 VIA EL PRADO STE 400
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5714
Mailing Address - Country:US
Mailing Address - Phone:310-792-8610
Mailing Address - Fax:
Practice Address - Street 1:1711 VIA EL PRADO STE 400
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHVARTSMAN SHIMADA DENTAL PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty