Provider Demographics
NPI:1831541804
Name:ELFERSI DENTAL CORPORATION
Entity type:Organization
Organization Name:ELFERSI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFERSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-761-0731
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 818
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3106
Mailing Address - Country:US
Mailing Address - Phone:323-761-0731
Mailing Address - Fax:323-761-0731
Practice Address - Street 1:8500 WILSHIRE BLVD STE 818
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3106
Practice Address - Country:US
Practice Address - Phone:323-761-0731
Practice Address - Fax:323-761-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty