Healthcare Provider Details

I. General information

NPI: 1699031898
Provider Name (Legal Business Name): LISA ANN ELENBERGER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 OAK AVE SUITE C
DAVIS CA
95616-1073
US

IV. Provider business mailing address

448 WILLIAMS ST
FOLSOM CA
95630-9558
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-7516
  • Fax: 530-756-0727
Mailing address:
  • Phone: 916-608-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number37543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: