Provider Demographics
NPI:1225238462
Name:SHULZHENKO, LARYSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARYSA
Middle Name:
Last Name:SHULZHENKO
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 1:10975 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice