1255463154 NPI number — ISABELLA SHTULMAN SOLOVEYCHIK D.D.S.

Table of content: DR. ADAM J MCINTYRE I DPT (NPI 1982288940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255463154 NPI number — ISABELLA SHTULMAN SOLOVEYCHIK D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLOVEYCHIK
Provider First Name:
ISABELLA
Provider Middle Name:
SHTULMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHTULMAN -SOLOVEYCHIK
Provider Other First Name:
ISABELLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1255463154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 CYPRESS HAWK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94582-5009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-968-9004
Provider Business Mailing Address Fax Number:
510-782-9944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19682 HESPERIAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94541-4752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-782-9942
Provider Business Practice Location Address Fax Number:
800-668-9530
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42228 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000007377 . This is a "PACIFICARE DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B42228-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000003937 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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