Provider Demographics
NPI:1831979905
Name:FIRST, SHOSHANA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:FIRST
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 1:4721 AQUEDUCT AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1618
Mailing Address - Country:US
Mailing Address - Phone:717-805-6310
Mailing Address - Fax:
Practice Address - Street 1:2621 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3505
Practice Address - Country:US
Practice Address - Phone:323-920-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1094781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice