Healthcare Provider Details

I. General information

NPI: 1679712863
Provider Name (Legal Business Name): ELISA STORBECK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA SANCHEZ ASCENCIO RDH

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

IV. Provider business mailing address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2266
  • Fax:
Mailing address:
  • Phone: 913-648-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2009020786
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6538
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11086
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: