1336245505 NPI number — ELGAN PITTS STAMPER III D.D.S.

Table of content: ELGAN PITTS STAMPER III D.D.S. (NPI 1336245505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336245505 NPI number — ELGAN PITTS STAMPER III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAMPER
Provider First Name:
ELGAN
Provider Middle Name:
PITTS
Provider Name Prefix Text:
Provider Name Suffix Text:
III
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:
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:
1336245505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 FOOTHILL BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LA CANADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91011-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-925-8183
Provider Business Mailing Address Fax Number:
818-952-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1370 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LA CANADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91011-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-925-8183
Provider Business Practice Location Address Fax Number:
818-952-6437
Provider Enumeration Date:
09/15/2006

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: 1223S0112X , with the licence number:  24870 , 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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