1790918423 NPI number — ELIAS, ELLIOTT, LAMPASI, FEHN, HARRIS & NGUYEN, ADC, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790918423 NPI number — ELIAS, ELLIOTT, LAMPASI, FEHN, HARRIS & NGUYEN, ADC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIAS, ELLIOTT, LAMPASI, FEHN, HARRIS & NGUYEN, ADC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OASIS FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790918423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41278 MARGARITA ROAD
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92591-5579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-598-8644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41278 MARGARITA RD
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92591-5579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-695-2290
Provider Business Practice Location Address Fax Number:
951-695-2291
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER PATIENT ACCOUNTING
Authorized Official Telephone Number:
951-241-7201

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  53239 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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