# PHILLIP J ELASSAL DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053959247
- **Authorized official:** PHILLIP JAMES ELASSAL DDS (DENTIST)
- **Authorized official phone:** (405) 682-0609

## Contact information

- **Practice address:** 1601 SW 89TH STREET \#G500, OKLAHOMA CITY, OK 73159
- **Practice address phone:** (405) 682-0609
- **Practice address fax:** (405) 682-2921
- **Mailing address:** PO BOX 890910, OKLAHOMA CITY, OK 73189
- **Mailing address phone:** (405) 682-0609
- **Mailing address fax:** (405) 682-2921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/18/2019
- **Last updated:** 12/18/2019