Provider Demographics
NPI:1114708484
Name:ELLIE STRASSER DDS INC
Entity Type:Organization
Organization Name:ELLIE STRASSER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-250-9501
Mailing Address - Street 1:49 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3436 HILLCREST AVE STE 150
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6305
Practice Address - Country:US
Practice Address - Phone:925-303-2615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty