# DR.'S SHTURMAN, MICHELSON AND KISILYUK A DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Medicine Providers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205129624
- **Authorized official:** MS. CHRISTINE CAMPBELL (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (916) 737-6453

## Contact information

- **Practice address:** 1050 NORTHGATE DR, 250B, SAN RAFAEL, CA 94903-2526
- **Practice address phone:** (415) 306-1456
- **Mailing address:** 1050 NORTHGATE DR, 250B, SAN RAFAEL, CA 94903-2526
- **Mailing address phone:** (415) 306-1456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 45975 | CA | Yes |

## Other

- **Enumeration date:** 05/18/2011
- **Last updated:** 05/18/2011