Provider Demographics
NPI:1558050377
Name:ELKESS, MARINA ELIZABETH (DMD)
Entity Type:Individual
Prefix:MISS
First Name:MARINA
Middle Name:ELIZABETH
Last Name:ELKESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:MARINA
Other - Middle Name:ELIZABETH
Other - Last Name:ELKESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13375 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3022
Mailing Address - Country:US
Mailing Address - Phone:818-983-3519
Mailing Address - Fax:
Practice Address - Street 1:13375 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3022
Practice Address - Country:US
Practice Address - Phone:818-983-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program