MEDICARE: LANA ELBORNO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38131	TX
2	1223G0001X	General Practice Dentistry	019.033197	IL

General Provider Information

NPI Number	:	1457929754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA ELBORNO DMD

Provider Business Mailing Address
First Line	:	777 S MAYDE CREEK DR APT 359
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-6157
Country	:	US
Telephone Number	:	630-400-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	12168 BELLAIRE BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2642
Country	:	US
Telephone Number	:	630-400-0104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	03/01/2022

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Directions to “ LANA ELBORNO DMD” Practice Location

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