Provider Demographics
NPI:1134314818
Name:ELIAS, ELLIOTT, LAMPASI, FEHN, HARRIS & NGUYEN, ADP
Entity Type:Organization
Organization Name:ELIAS, ELLIOTT, LAMPASI, FEHN, HARRIS & NGUYEN, ADP
Other - Org Name:RIVERSIDE DENTAL GROUP AT WOODCREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-241-7201
Mailing Address - Street 1:19009 VAN BUREN BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9164
Mailing Address - Country:US
Mailing Address - Phone:951-776-9001
Mailing Address - Fax:951-680-1995
Practice Address - Street 1:19009 VAN BUREN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9164
Practice Address - Country:US
Practice Address - Phone:951-776-9001
Practice Address - Fax:951-680-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty