Provider Demographics
NPI:1285107235
Name:SHUSKO, ERIN HONG (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:HONG
Last Name:SHUSKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9612 LUCERNE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2927
Mailing Address - Country:US
Mailing Address - Phone:925-330-4786
Mailing Address - Fax:
Practice Address - Street 1:8350 E RAINTREE DR STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2691
Practice Address - Country:US
Practice Address - Phone:480-609-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060030-1122300000X
CA1062361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist