Provider Demographics
NPI:1750692794
Name:JUSTICE, ELENA GUENNADIEVNA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:GUENNADIEVNA
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1771 W ROMNEYA DR STE F
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1817
Mailing Address - Country:US
Mailing Address - Phone:714-774-8360
Mailing Address - Fax:714-774-3212
Practice Address - Street 1:1771 W ROMNEYA DR STE F
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1817
Practice Address - Country:US
Practice Address - Phone:714-774-8360
Practice Address - Fax:714-774-3212
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics