Provider Demographics
NPI:1417551706
Name:SCHLOSSBERG, ELYSSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELYSSA
Middle Name:
Last Name:SCHLOSSBERG
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 1:9201 W SUNSET BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3707
Mailing Address - Country:US
Mailing Address - Phone:310-273-9322
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 601
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3707
Practice Address - Country:US
Practice Address - Phone:310-273-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist