Provider Demographics
NPI:1609221068
Name:ELPERIN DDS, PLLC
Entity Type:Organization
Organization Name:ELPERIN DDS, PLLC
Other - Org Name:SUNRISE DENTAL OF ELLENSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:COSTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-925-3160
Mailing Address - Street 1:306 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-925-3160
Mailing Address - Fax:509-232-7181
Practice Address - Street 1:306 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3608
Practice Address - Country:US
Practice Address - Phone:509-925-3160
Practice Address - Fax:509-232-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601695891223G0001X
WADE605122431223G0001X
WADE605590411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty