Provider Demographics
NPI:1316359649
Name:BEACH VIEW DENTAL SLEEP THERAPY
Entity Type:Organization
Organization Name:BEACH VIEW DENTAL SLEEP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELENBAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-896-1840
Mailing Address - Street 1:1924 E PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3715
Mailing Address - Country:US
Mailing Address - Phone:228-896-1840
Mailing Address - Fax:228-604-4449
Practice Address - Street 1:1924 E PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3715
Practice Address - Country:US
Practice Address - Phone:228-896-1840
Practice Address - Fax:228-604-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2394-961223G0001X
MS2260-861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty