Provider Demographics
NPI:1326171901
Name:DRS ELLENDER AND ELLENDER A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DRS ELLENDER AND ELLENDER A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-527-6751
Mailing Address - Street 1:910 1ST AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3425
Mailing Address - Country:US
Mailing Address - Phone:337-527-6751
Mailing Address - Fax:337-527-6751
Practice Address - Street 1:910 1ST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3425
Practice Address - Country:US
Practice Address - Phone:337-527-6751
Practice Address - Fax:337-527-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty