Provider Demographics
NPI:1790400679
Name:NOURA ELLOWAY RDH RANDAL ELLOWAY DDS CORP
Entity Type:Organization
Organization Name:NOURA ELLOWAY RDH RANDAL ELLOWAY DDS CORP
Other - Org Name:DENTAL SLEEP SOLUTIONS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-727-6080
Mailing Address - Street 1:2426 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2426 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4337
Practice Address - Country:US
Practice Address - Phone:530-727-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty