Provider Demographics
NPI:1841751310
Name:DAYRIT, ELMIRRA JEANINAH M (DDS)
Entity Type:Individual
Prefix:
First Name:ELMIRRA
Middle Name:JEANINAH M
Last Name:DAYRIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21709 MEEKLAND AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3819
Mailing Address - Country:US
Mailing Address - Phone:510-589-1014
Mailing Address - Fax:
Practice Address - Street 1:3107 LONE TREE WAY STE A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4959
Practice Address - Country:US
Practice Address - Phone:925-757-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAD1052971223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program