Provider Demographics
NPI:1679850556
Name:OCHOA, ELISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:OCHOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 87TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7409
Mailing Address - Country:US
Mailing Address - Phone:630-427-2019
Mailing Address - Fax:
Practice Address - Street 1:2019 87TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7409
Practice Address - Country:US
Practice Address - Phone:630-427-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist