Provider Demographics
NPI:1710922976
Name:CHARNEY, ELISA DONNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:DONNA
Last Name:CHARNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:DONNA
Other - Last Name:BERKOWITZ-CHARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6253 SHADYCREEK DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1649
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:11901 WILSHIRE BLVD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist