Provider Demographics
NPI:1386942118
Name:ELBERT, DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:ELBERT
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 1:2166 N MOORPARK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5011
Mailing Address - Country:US
Mailing Address - Phone:805-492-3553
Mailing Address - Fax:805-435-4123
Practice Address - Street 1:2166 N MOORPARK RD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5011
Practice Address - Country:US
Practice Address - Phone:805-492-3553
Practice Address - Fax:805-435-4123
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice