Provider Demographics
NPI:1760881965
Name:MCANINCH, ELYSE MARIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:MARIE
Last Name:MCANINCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:MARIE
Other - Last Name:GARIBALDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1895 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1895 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6024
Practice Address - Country:US
Practice Address - Phone:831-274-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics