Provider Demographics
NPI:1831534320
Name:ELSON, MARC STUART (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STUART
Last Name:ELSON
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2942
Mailing Address - Country:US
Mailing Address - Phone:805-495-3010
Mailing Address - Fax:805-495-3024
Practice Address - Street 1:2125 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2942
Practice Address - Country:US
Practice Address - Phone:805-495-3010
Practice Address - Fax:805-495-3024
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist