Provider Demographics
NPI:1003131491
Name:ELIHU, DOREECE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOREECE
Middle Name:
Last Name:ELIHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DOREECE
Other - Middle Name:ELIHU
Other - Last Name:ARTAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1125 S BEVERLY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1148
Mailing Address - Country:US
Mailing Address - Phone:310-927-6084
Mailing Address - Fax:310-286-7887
Practice Address - Street 1:1125 S BEVERLY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1148
Practice Address - Country:US
Practice Address - Phone:310-927-6084
Practice Address - Fax:310-286-7887
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6368590001Medicare NSC