MEDICARE: MISS MARINA ELIZABETH ELKESS 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	110157	CA

General Provider Information

NPI Number	:	1558050377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARINA ELIZABETH ELKESS DMD

Provider Business Mailing Address
First Line	:	13375 WHEELER AVE
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-3022
Country	:	US
Telephone Number	:	818-983-3519
Fax Number	:

Provider Business Practice Location Address
First Line	:	8393 TOPANGA CANYON BLVD
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2343
Country	:	US
Telephone Number	:	818-227-8986
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	07/01/2024

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