Provider Demographics
NPI:1871611863
Name:GRINBERG, INESSA DAVIDONNA (DDS)
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:DAVIDONNA
Last Name:GRINBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 22ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-876-1910
Mailing Address - Fax:415-751-6154
Practice Address - Street 1:6100 CALIFORNIA ST
Practice Address - Street 2:CALIFORNIA DENTAL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121
Practice Address - Country:US
Practice Address - Phone:415-751-6108
Practice Address - Fax:415-751-6154
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD43341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43341Medicaid