Provider Demographics
NPI:1700940129
Name:ELANNAN, ERICA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:NICOLE
Last Name:ELANNAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:ELANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 43262
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-3262
Mailing Address - Country:US
Mailing Address - Phone:206-850-3467
Mailing Address - Fax:
Practice Address - Street 1:4025 W BELL RD STE 14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2749
Practice Address - Country:US
Practice Address - Phone:206-850-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16541122300000X
AZD058511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist