Provider Demographics
NPI:1922237478
Name:ELLIFF, LAURA KATHRYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KATHRYN
Last Name:ELLIFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2794
Mailing Address - Country:US
Mailing Address - Phone:630-450-3572
Mailing Address - Fax:
Practice Address - Street 1:1912 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2794
Practice Address - Country:US
Practice Address - Phone:630-450-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist