MEDICARE: DR. ELAINE ASANAKI DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223P0221X	Pediatric Dentistry	DN1856107	MA
3	1223P0221X	Pediatric Dentistry	010521	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174834030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE ASANAKI DMD

Provider Business Mailing Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4447
Fax Number	:	719-583-1801

Provider Business Practice Location Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4447
Fax Number	:	719-583-1801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	12/11/2016

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