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General NPI Number Information
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NPI Number | 1457929754
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Entity Type | Individual
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Provider Name | LANA ELBORNO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 12168 BELLAIRE BLVD STE 100
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City | HOUSTON
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State | TX
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Zip | 77072-2642
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Country | US
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Telephone | 630-400-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 777 S MAYDE CREEK DR APT 359
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City | HOUSTON
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State | TX
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Zip | 77079-6157
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Country | US
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Telephone | 630-400-0104
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38131
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033197
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License Number State | IL
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