Provider Demographics
NPI:1659655090
Name:SIN, ELISA (DMD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:SIN
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 1:41250 12TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1444
Mailing Address - Country:US
Mailing Address - Phone:617-620-0873
Mailing Address - Fax:
Practice Address - Street 1:41250 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1444
Practice Address - Country:US
Practice Address - Phone:617-620-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602498111223P0300X
CA564221223P0300X
AZD073981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics