Provider Demographics
NPI:1063382778
Name:ELENA STAN CORP
Entity type:Organization
Organization Name:ELENA STAN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-495-3832
Mailing Address - Street 1:301 WINDMILL CANYON PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1904
Mailing Address - Country:US
Mailing Address - Phone:925-495-3832
Mailing Address - Fax:
Practice Address - Street 1:5047 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3006
Practice Address - Country:US
Practice Address - Phone:925-495-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty