Provider Demographics
NPI:1215383260
Name:JOSEPH L. ELIASON, DDS, MSD, APC
Entity Type:Organization
Organization Name:JOSEPH L. ELIASON, DDS, MSD, APC
Other - Org Name:SMILE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:707-548-4880
Mailing Address - Street 1:1880 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4953
Mailing Address - Country:US
Mailing Address - Phone:707-546-4880
Mailing Address - Fax:707-546-0166
Practice Address - Street 1:1880 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4953
Practice Address - Country:US
Practice Address - Phone:707-546-4880
Practice Address - Fax:707-546-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty