Provider Demographics
NPI:1861806564
Name:ELDER, STEVE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:ELDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5921
Mailing Address - Country:US
Mailing Address - Phone:310-937-6100
Mailing Address - Fax:310-937-6102
Practice Address - Street 1:600 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5921
Practice Address - Country:US
Practice Address - Phone:310-937-6100
Practice Address - Fax:310-937-6102
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice