Provider Demographics
NPI:1710768643
Name:OROFACIAL PAIN, PLLC
Entity Type:Organization
Organization Name:OROFACIAL PAIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:BURGER
Authorized Official - Last Name:ELENBAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:228-303-1700
Mailing Address - Street 1:370 COURTHOUSE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1889
Mailing Address - Country:US
Mailing Address - Phone:228-203-1700
Mailing Address - Fax:228-203-1770
Practice Address - Street 1:370 COURTHOUSE RD STE 103
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1889
Practice Address - Country:US
Practice Address - Phone:228-203-1700
Practice Address - Fax:228-203-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty