Provider Demographics
NPI:1629667266
Name:SCHOLTEN, SHIRA FENYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:FENYA
Last Name:SCHOLTEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHIRA
Other - Middle Name:FENYA
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1200 S BROADWAY APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4322
Mailing Address - Country:US
Mailing Address - Phone:302-528-4340
Mailing Address - Fax:
Practice Address - Street 1:1200 S BROADWAY APT 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4322
Practice Address - Country:US
Practice Address - Phone:302-528-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ105621223G0001X
CA1060241223G0001X
CADDS1060241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice