MEDICARE: ELAHE WISSINGER PLLC

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	:	1093499857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAHE WISSINGER PLLC

Provider Business Mailing Address
First Line	:	2504 E RIVER RD # 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-9555
Country	:	US
Telephone Number	:	520-745-5496
Fax Number	:	520-745-5971

Provider Business Practice Location Address
First Line	:	2504 E RIVER RD # 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-9555
Country	:	US
Telephone Number	:	520-745-5496
Fax Number	:	520-745-5971

Authorized Official
Title or Position	:	ADMIN ASST
Name	:	JORGIA BARFIELD
Credential	:
Telephone Number	:	520-745-5496

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “ELAHE WISSINGER PLLC ” Practice Location

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