Provider Demographics
NPI:1275782641
Name:ELLIOT PAUL SCHLANG DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ELLIOT PAUL SCHLANG DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHLANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:877-227-9892
Mailing Address - Street 1:2550 W UNION HILLS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:877-227-9892
Mailing Address - Fax:623-321-6268
Practice Address - Street 1:240 18TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2404
Practice Address - Country:US
Practice Address - Phone:877-227-9892
Practice Address - Fax:623-321-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty