Provider Demographics
NPI:1710225776
Name:SHAMSA, LAILA (RDHAP)
Entity Type:Individual
Prefix:MISS
First Name:LAILA
Middle Name:
Last Name:SHAMSA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 573414
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3414
Mailing Address - Country:US
Mailing Address - Phone:818-770-6710
Mailing Address - Fax:
Practice Address - Street 1:6316 LINDLEY AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-7119
Practice Address - Country:US
Practice Address - Phone:818-770-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist