Healthcare Provider Details

I. General information

NPI: 1104908433
Provider Name (Legal Business Name): ANTHONY J. ELFORD DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E 22ND AVE BLDG F
EUGENE OR
97405-2989
US

IV. Provider business mailing address

622 E 22ND AVE BLDG F
EUGENE OR
97405-2989
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-6371
  • Fax: 544-344-5451
Mailing address:
  • Phone: 541-344-6371
  • Fax: 544-344-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7890
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHIELA ANN GIBSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-344-6371