Provider Demographics
NPI:1336281906
Name:ELAZEGUI, ROLAND LLORENTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:LLORENTE
Last Name:ELAZEGUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3700
Mailing Address - Country:US
Mailing Address - Phone:408-719-8295
Mailing Address - Fax:408-719-8297
Practice Address - Street 1:1156 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-719-8295
Practice Address - Fax:408-719-8297
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice