Provider Demographics
NPI:1164641049
Name:SHULZHENKO DENTAL, INC
Entity Type:Organization
Organization Name:SHULZHENKO DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULZHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-890-9990
Mailing Address - Street 1:10975 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1632
Mailing Address - Country:US
Mailing Address - Phone:818-890-9990
Mailing Address - Fax:818-890-9144
Practice Address - Street 1:10975 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1632
Practice Address - Country:US
Practice Address - Phone:818-890-9990
Practice Address - Fax:818-890-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty