Provider Demographics
NPI:1689897720
Name:ELENES, DANIEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:ELENES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2529
Mailing Address - Country:US
Mailing Address - Phone:323-376-6372
Mailing Address - Fax:
Practice Address - Street 1:11330 LONG BEACH BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3340
Practice Address - Country:US
Practice Address - Phone:310-637-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92588-01OtherDENTICAL
CA954129234OtherDELTA DENTAL