Provider Demographics
NPI:1386828218
Name:LING, ELLEN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:N
Last Name:LING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 HIGHWAY 104
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640-1363
Mailing Address - Country:US
Mailing Address - Phone:209-274-4911
Mailing Address - Fax:209-274-5167
Practice Address - Street 1:4001 HWY 104
Practice Address - Street 2:
Practice Address - City:IONE
Practice Address - State:CA
Practice Address - Zip Code:95640-1363
Practice Address - Country:US
Practice Address - Phone:209-274-4911
Practice Address - Fax:209-274-5167
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist