Provider Demographics
NPI:1699405027
Name:ELITE SEDATION GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:ELITE SEDATION GENERAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ANESTHESIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMASRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-288-3401
Mailing Address - Street 1:30262 CROWN VALLEY PKWY STE B447
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2364
Mailing Address - Country:US
Mailing Address - Phone:949-288-3401
Mailing Address - Fax:
Practice Address - Street 1:30262 CROWN VALLEY PKWY STE B447
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2364
Practice Address - Country:US
Practice Address - Phone:949-288-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790101244Medicaid