Provider Demographics
NPI:1093157042
Name:ELIE PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:ELIE PROFESSIONAL DENTAL CORPORATION
Other - Org Name:VALENCIA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-799-0886
Mailing Address - Street 1:2860 MICHELLE FL 2
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1008
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:26938 THE OLD RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91381-0662
Practice Address - Country:US
Practice Address - Phone:661-799-0886
Practice Address - Fax:661-799-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty