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General NPI Number Information
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NPI Number | 1689897720
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Entity Type | Individual
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Provider Name | DANIEL ELENES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11330 LONG BEACH BLVD SUITE #100
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City | LYNWOOD
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State | CA
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Zip | 90262-3340
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Country | US
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Telephone | 310-637-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 940 LEXINGTON AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-2529
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Country | US
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Telephone | 323-376-6372
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30715
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License Number State | CA
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