Provider Demographics
NPI:1780990721
Name:SHLOSBERG, STUART ROBERT
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ROBERT
Last Name:SHLOSBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR STE 925
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4520
Mailing Address - Country:US
Mailing Address - Phone:310-275-2220
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR STE 925
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4520
Practice Address - Country:US
Practice Address - Phone:310-275-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist