Provider Demographics
NPI:1962518696
Name:SOURS, ELAINE K (DDS)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:K
Last Name:SOURS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4506
Mailing Address - Country:US
Mailing Address - Phone:703-369-5544
Mailing Address - Fax:703-361-3680
Practice Address - Street 1:8719 PLANTATION LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-369-5544
Practice Address - Fax:703-361-3680
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice