Provider Demographics
NPI:1750774287
Name:ELLASHEK DENTAL LLC
Entity type:Organization
Organization Name:ELLASHEK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLASHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-702-8500
Mailing Address - Street 1:3665 STUTZ DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9144
Mailing Address - Country:US
Mailing Address - Phone:330-702-8500
Mailing Address - Fax:
Practice Address - Street 1:3665 STUTZ DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9144
Practice Address - Country:US
Practice Address - Phone:330-702-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.015819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty