Healthcare Provider Details

I. General information

NPI: 1154420701
Provider Name (Legal Business Name): DWAYNE ARTHUR ELDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 SAGUNTO ST STE. 102
SANTA YNEZ CA
93460-9151
US

IV. Provider business mailing address

PO BOX 1013
SANTA YNEZ CA
93460-1013
US

V. Phone/Fax

Practice location:
  • Phone: 805-693-1414
  • Fax: 805-693-8006
Mailing address:
  • Phone: 805-693-1414
  • Fax: 805-693-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: