Provider Demographics
NPI:1588773360
Name:SCHLOSSER, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHLOSSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SOUTH LASKY DRIVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1741
Mailing Address - Country:US
Mailing Address - Phone:310-552-1441
Mailing Address - Fax:310-552-4503
Practice Address - Street 1:153 SOUTH LASKY DRIVE
Practice Address - Street 2:SUITE #5
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1741
Practice Address - Country:US
Practice Address - Phone:310-552-1441
Practice Address - Fax:310-552-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist