Healthcare Provider Details

I. General information

NPI: 1992845986
Provider Name (Legal Business Name): ELIAS,ELLIOTT,LAMPASI,FEHN, & HARRIS ADP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 CENTRAL AVE
RIVERSIDE CA
92506-2115
US

IV. Provider business mailing address

3487 CENTRAL AVE
RIVERSIDE CA
92506-2115
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-1001
  • Fax: 951-369-1007
Mailing address:
  • Phone: 951-369-1001
  • Fax: 951-369-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number45892
License Number StateCA

VIII. Authorized Official

Name: DON MA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 951-689-5031