Healthcare Provider Details

I. General information

NPI: 1679394084
Provider Name (Legal Business Name): ELENITA MELIKTERMINAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 VENTURA BLVD STE C101
STUDIO CITY CA
91604-2639
US

IV. Provider business mailing address

3336 STEPHENS CIR
GLENDALE CA
91208-1169
US

V. Phone/Fax

Practice location:
  • Phone: 818-441-6058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: