1275662736 NPI number — DR. ELLIOTT STEVEN DUSHKIN D.D.S.

Table of content: DR. ELLIOTT STEVEN DUSHKIN D.D.S. (NPI 1275662736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275662736 NPI number — DR. ELLIOTT STEVEN DUSHKIN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUSHKIN
Provider First Name:
ELLIOTT
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUSHKIN
Provider Other First Name:
ELLIOTT
Provider Other Middle Name:
STEVEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275662736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 ALHAMBRA AVENUE
Provider Second Line Business Mailing Address:
CONTRA COSTA COUNTY REGIONAL HEALTH CENTER
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94553-3191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-671-7477
Provider Business Mailing Address Fax Number:
925-691-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ALHAMBRA AVENUE
Provider Second Line Business Practice Location Address:
CONTRA COSTA COUNTY REGIONAL HEALTH CENTER
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553-3191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-671-7477
Provider Business Practice Location Address Fax Number:
925-691-9671
Provider Enumeration Date:
03/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  26754 , 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)