Provider Demographics
NPI:1548047772
Name:BACH, ELYA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELYA
Middle Name:
Last Name:BACH
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 1:4402 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3033
Mailing Address - Country:US
Mailing Address - Phone:310-489-1946
Mailing Address - Fax:
Practice Address - Street 1:9331 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3882
Practice Address - Country:US
Practice Address - Phone:619-448-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1091401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice