Provider Demographics
NPI:1992845986
Name:ELIAS,ELLIOTT,LAMPASI,FEHN, & HARRIS ADP
Entity Type:Organization
Organization Name:ELIAS,ELLIOTT,LAMPASI,FEHN, & HARRIS ADP
Other - Org Name:DENTAL ASSOCIATES OF RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-689-5031
Mailing Address - Street 1:3487 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2115
Mailing Address - Country:US
Mailing Address - Phone:951-369-1001
Mailing Address - Fax:951-369-1007
Practice Address - Street 1:3487 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2115
Practice Address - Country:US
Practice Address - Phone:951-369-1001
Practice Address - Fax:951-369-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty