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General NPI Number Information
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NPI Number | 1316244809
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Entity Type | Organization
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Legal Business Name | ELLIFF DENTAL P.C.
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 1912 W WILSON ST
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City | BATAVIA
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State | IL
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Zip | 60510-2794
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Country | US
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Telephone | 630-450-3572
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 W WILSON ST
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City | BATAVIA
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State | IL
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Zip | 60510-2794
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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 | PRESIDENT
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Name | DR. LAURA K ELLIFF
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Credential |
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Telephone | 630-450-3572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028009
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019027402
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License Number State | IL
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