MEDICARE: ELIE PROFESSIONAL DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1093157042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIE PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2860 MICHELLE FL 2
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-1008
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	26938 THE OLD RD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-0662
Country	:	US
Telephone Number	:	661-799-0886
Fax Number	:	661-799-2655

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. ARASH ELIE
Credential	:	DDS
Telephone Number	:	661-799-0886

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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