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General NPI Number Information
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NPI Number | 1265740781
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Entity Type | Individual
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Provider Name | ARAGON ELLWANGER
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Gender | Male
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1655 SOUTHGATE AVE STE 200
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City | DALY CITY
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State | CA
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Zip | 94015-2302
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Country | US
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Telephone | 650-991-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 301 THE ALAMEDA UNIT 370
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City | SAN JUAN BAUTISTA
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State | CA
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Zip | 95045-7012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 59576
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License Number State | CA
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