Provider Demographics
NPI:1407182629
Name:ELAN DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:ELAN DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARPER
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-447-6290
Mailing Address - Street 1:16154 MAIN AVE SE
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4800
Mailing Address - Country:US
Mailing Address - Phone:952-447-6290
Mailing Address - Fax:952-447-6292
Practice Address - Street 1:16154 MAIN AVE SE
Practice Address - Street 2:SUITE 110A
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4800
Practice Address - Country:US
Practice Address - Phone:952-447-6290
Practice Address - Fax:952-447-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11026261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental