Provider Demographics
NPI:1336241108
Name:VENTON, ELLEN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ANN
Last Name:VENTON
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 1:296 ARLINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1496
Mailing Address - Country:US
Mailing Address - Phone:510-524-3236
Mailing Address - Fax:510-524-1134
Practice Address - Street 1:296 ARLINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94707-1496
Practice Address - Country:US
Practice Address - Phone:510-524-3236
Practice Address - Fax:510-524-1134
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist