Healthcare Provider Details

I. General information

NPI: 1760624662
Provider Name (Legal Business Name): ELANA YERUSHALMI NORMAN, DDS, MS, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD STE 500E
SANTA MONICA CA
90404-2157
US

IV. Provider business mailing address

853 16TH ST APT 4
SANTA MONICA CA
90403-1819
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-6758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number56855
License Number StateCA

VIII. Authorized Official

Name: DR. ELANA YERUSHALMI NORMAN
Title or Position: PRESIDENT/OWNER
Credential: DDS, MS
Phone: 310-991-6758