Provider Demographics
NPI:1518080118
Name:RUMACK, ELENA (DDS)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:RUMACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:SIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:23679 CALABASAS RD
Mailing Address - Street 2:SUITE # 983
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1502
Mailing Address - Country:US
Mailing Address - Phone:818-222-4543
Mailing Address - Fax:818-591-7599
Practice Address - Street 1:23695 CALABASAS RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1502
Practice Address - Country:US
Practice Address - Phone:818-222-4543
Practice Address - Fax:818-591-7599
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist