Provider Demographics
NPI:1699031898
Name:ELENBERGER, LISA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:ELENBERGER
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 1:448 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9558
Mailing Address - Country:US
Mailing Address - Phone:916-608-0902
Mailing Address - Fax:
Practice Address - Street 1:1791 OAK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1073
Practice Address - Country:US
Practice Address - Phone:530-756-7516
Practice Address - Fax:530-756-0727
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry