Provider Demographics
NPI:1225414527
Name:ELLORIN, ELAINE GRACE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE GRACE
Middle Name:
Last Name:ELLORIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911B E DUANE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3438
Mailing Address - Country:US
Mailing Address - Phone:408-736-7299
Mailing Address - Fax:408-736-7298
Practice Address - Street 1:911B E DUANE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-3438
Practice Address - Country:US
Practice Address - Phone:408-736-7299
Practice Address - Fax:408-736-7298
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist