Provider Demographics
NPI:1427015957
Name:ELSTON, STEPHEN VINCENT (STEPHEN ELSTON)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VINCENT
Last Name:ELSTON
Suffix:
Gender:M
Credentials:STEPHEN ELSTON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 RHODE ISLAND AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4069
Mailing Address - Country:US
Mailing Address - Phone:763-525-1800
Mailing Address - Fax:612-379-3029
Practice Address - Street 1:96 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1852
Practice Address - Country:US
Practice Address - Phone:612-379-3028
Practice Address - Fax:612-379-3029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist