Ellefson & Marelich Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

DDS100710 Issued in CA

Legal business name

ELLEFSON & MARELICH DENTAL CORPORATION

Practice address

1100 Sonoma Ave
Suite a
Santa Rosa, CA 95405

Phone

(707) 527-0363

Fax

(707) 527-6735

NPI assigned

Sep 7, 2017

Organization subpart

No

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

Authorized official

Name

Laura David Ellefson, DMDNPI 1427398882

Title

Dentist

Phone

(707) 527-0363

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura David Ellefson, DMD

  • Dentist
  • Santa Rosa, CA
  • NPI 1427398882
  NPD Authorized official
• Sheena Phan-Wu

  • Dentist
  • Santa Rosa, CA
  • NPI 1235578386
  NPD (past)

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504742400000",
    "number": "1942728241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE",
            "address_2": "SUITE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-527-0363",
            "fax_number": "707-527-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE",
            "address_2": "SUITE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-527-0363",
            "fax_number": "707-527-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEFSON & MARELICH DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-07",
        "last_updated": "2017-09-07",
        "status": "A",
        "authorized_official_last_name": "ELLEFSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "707-527-0363",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS100710",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew John Elias
• Robert Elias, M.D.
• Stefany Elias
• Joseph Eliason, DDS, MSD
• Anita Marie Eliot, MA LMFT
• Laura David Ellefson, DMD
• Mary Ileen Elliff, CRNFA
• Monique Ellington
• Eric Elliott
• Jeffrey Craig Elliott, D.D.S.

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.