Provider Demographics
NPI:1558568311
Name:JEFFREY A. ELO, DDS, MS, INC.
Entity Type:Organization
Organization Name:JEFFREY A. ELO, DDS, MS, INC.
Other - Org Name:SOUTH COAST ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:714-556-7000
Mailing Address - Street 1:2740 S BRISTOL ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6209
Mailing Address - Country:US
Mailing Address - Phone:714-556-7000
Mailing Address - Fax:
Practice Address - Street 1:2740 S BRISTOL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6209
Practice Address - Country:US
Practice Address - Phone:714-556-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty