Healthcare Provider Details

I. General information

NPI: 1831541804
Provider Name (Legal Business Name): ELFERSI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 818
BEVERLY HILLS CA
90211-3106
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 818
BEVERLY HILLS CA
90211-3106
US

V. Phone/Fax

Practice location:
  • Phone: 323-761-0731
  • Fax: 323-761-0731
Mailing address:
  • Phone: 323-761-0731
  • Fax: 323-761-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number64203
License Number StateCA

VIII. Authorized Official

Name: DR. TALI ELFERSI
Title or Position: OWNER
Credential: DDS
Phone: 323-761-0731