Provider Demographics
NPI:1316085418
Name:ELENBERGER, JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:ELENBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 ROCKLIN RD
Mailing Address - Street 2:#1
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2862
Mailing Address - Country:US
Mailing Address - Phone:916-624-5557
Mailing Address - Fax:916-624-5501
Practice Address - Street 1:4240 ROCKLIN RD
Practice Address - Street 2:#1
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2862
Practice Address - Country:US
Practice Address - Phone:916-624-5557
Practice Address - Fax:916-624-5501
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics