NPIMap

Organization Active NPI

Elenes Dental Corporation

Doing business as Legacy Dental

  • Dental Laboratory
  • San Bernardino, CA
National Provider Identifier
1477851582
Registry record updated Mar 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental LaboratoryTaxonomy code 292200000X
License
30715 Issued in CA
Legal business name
ELENES DENTAL CORPORATION
Doing business as
Legacy Dental
Practice address
245 N Waterman Ave
Suite H
San Bernardino, CA 92408-1209
Phone
(909) 884-0369
Fax
(909) 884-0426
NPI assigned
Mar 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Daniel Elenes, D.D.S.
Title
President
Phone
(909) 884-0369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Laboratory 292200000X 30715 CA Primary

Addresses

Primary practice location

245 N Waterman Ave
Suite H
San Bernardino, CA 92408-1209

Mailing address

245 N Waterman Ave
Suite H
San Bernardino, CA 92408-1209
Phone (909) 884-0369

Other names 1

  • Legacy Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elenes Dental Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

245 N Waterman Ave
Ste H
San Bernardino, CA 92408
Phone (909) 884-0369

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300060800000",
    "number": "1477851582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N WATERMAN AVE",
            "address_2": "SUITE H",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924081209",
            "telephone_number": "909-884-0369",
            "fax_number": "909-884-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N WATERMAN AVE",
            "address_2": "SUITE H",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924081209",
            "telephone_number": "909-884-0369",
            "fax_number": "909-884-0426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELENES DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-14",
        "last_updated": "2011-03-14",
        "status": "A",
        "authorized_official_last_name": "ELENES",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-884-0369",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "30715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.