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General NPI Number Information
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NPI Number | 1427015957
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Entity Type | Individual
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Provider Name | STEPHEN VINCENT ELSTON STEPHEN ELSTON
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 96 BROADWAY ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1852
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Country | US
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Telephone | 612-379-3028
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Fax | 612-379-3029
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Provider Business Mailing Address
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Address Line | 1800 RHODE ISLAND AVE N
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4069
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Country | US
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Telephone | 763-525-1800
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Fax | 612-379-3029
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6959
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License Number State | MN
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