Healthcare Provider Details

I. General information

NPI: 1174834030
Provider Name (Legal Business Name): ELAINE ASANAKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 12/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 8TH ST SUITE 810
PUEBLO CO
81003-3038
US

IV. Provider business mailing address

201 W 8TH ST SUITE 810
PUEBLO CO
81003-3038
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-4447
  • Fax: 719-583-1801
Mailing address:
  • Phone: 719-562-4447
  • Fax: 719-583-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1856107
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number010521
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: