Provider Demographics
NPI:1174834030
Name:ASANAKI, ELAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:ASANAKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:201 W 8TH ST
Practice Address - Street 2:SUITE 810
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3038
Practice Address - Country:US
Practice Address - Phone:719-562-4447
Practice Address - Fax:719-583-1801
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18561071223P0221X
CT0105211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089498AMedicaid
CT008032579Medicaid