Provider Demographics
NPI:1801625025
Name:CRISTOFARO, ELLERY SOPHIA
Entity type:Individual
Prefix:MISS
First Name:ELLERY
Middle Name:SOPHIA
Last Name:CRISTOFARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 G ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3408
Mailing Address - Country:US
Mailing Address - Phone:360-510-9145
Mailing Address - Fax:
Practice Address - Street 1:1310 J ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2913
Practice Address - Country:US
Practice Address - Phone:360-676-7130
Practice Address - Fax:360-676-1125
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant