Provider Demographics
NPI:1295405777
Name:ELIAS, SERGIO AUGUSTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:AUGUSTO
Last Name:ELIAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 GOODRICH RD APT 111
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1634
Mailing Address - Country:US
Mailing Address - Phone:305-342-3382
Mailing Address - Fax:
Practice Address - Street 1:8951 GOODRICH RD APT 111
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1634
Practice Address - Country:US
Practice Address - Phone:305-342-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN262351223G0001X
MND149971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice