Kerisa Sue Elloway in Fortuna - Pediatric Dentistry
Kerisa Sue Elloway - NPI 1154452324
Kerisa Sue Elloway is a Pediatric Dentistry in Fortuna, California. Kerisa Sue Elloway practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for Kerisa Sue Elloway is 1154452324. The last update date is 2007-07-08.
Kerisa Sue Elloway's current location address is 1730 Main St Ste A, Fortuna, California. You can contact this provider via phone number 7077251303 and fax number 7077251358. The mailing address for Kerisa Sue Elloway is 1730 Main St Ste A, Fortuna, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kerisa Sue Elloway |
|---|---|
| Address | 1730 Main St Ste A, Fortuna, California |
| Phone Number | 7077251303 |
| Fax Number | 7077251358 |
| Sole Proprietor | Y |
| Credentials | D.D.S. |
NPI Number Detail
| NPI Number | 1154452324 |
|---|---|
| Provider Enumeration Date | 2007-03-08 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 1730 Main St Ste A |
|---|---|
| City | Fortuna |
| State | California (CA) |
| Post Code | 955402451 |
| Phone Number | 7077251303 |
| Fax Number | 7077251358 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | 47254 |
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Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
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Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Kerisa Sue Elloway by the Centers for Medicare & Medicaid Services?
The Kerisa Sue Elloway has been issued the NPI (National Provider Identifier) 1154452324, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Kerisa Sue Elloway is geographically located?
The Kerisa Sue Elloway is physically situated at the following location: 1730 Main St Ste A, Fortuna, CA, 955402451.
What is Kerisa Sue Elloway's area of expertise and its corresponding taxonomy classification?
The Kerisa Sue Elloway's field of specialization is Pediatric Dentistry, and it falls under the taxonomy code 1223P0221X, which categorizes healthcare providers based on their areas of practice.
On what date did the Kerisa Sue Elloway receive the assignment of its 1154452324 from the Centers for Medicare & Medicaid Services?
The Kerisa Sue Elloway was issued its 1154452324 by the Centers for Medicare & Medicaid Services on 2007-03-08.
As of what date were the details related to Kerisa Sue Elloway most recently updated or revised?
The information pertaining to Kerisa Sue Elloway, including its address, specialty, and other relevant details, was last updated or revised on 2007-07-08.