Provider Demographics
NPI:1639704422
Name:ARCALA, ELLEN VENCILAO (DMD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:VENCILAO
Last Name:ARCALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 MISSION AVE STE 138
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1459
Mailing Address - Country:US
Mailing Address - Phone:760-439-2626
Mailing Address - Fax:
Practice Address - Street 1:3776 MISSION AVE STE 138
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1459
Practice Address - Country:US
Practice Address - Phone:760-439-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice