Provider Demographics
NPI:1558867473
Name:PARAJON-AFLATOON, ELLIE
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:
Last Name:PARAJON-AFLATOON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:PARAJON-AFLATOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:54 RENATA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1231
Mailing Address - Country:US
Mailing Address - Phone:949-836-2796
Mailing Address - Fax:
Practice Address - Street 1:10500 MAGNOLIA AVE STE A1A1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5817
Practice Address - Country:US
Practice Address - Phone:949-836-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS540771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice