# ELENES DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508165929
- **Authorized official:** DR. DANIEL ELENES D.D.S. (PRESIDENT)
- **Authorized official phone:** (310) 637-2600

## Contact information

- **Practice address:** 11330 LONG BEACH BLVD, SUITE 100, LYNWOOD, CA 90262-3340
- **Practice address phone:** (310) 637-2600
- **Practice address fax:** (310) 637-2638
- **Mailing address:** 11330 LONG BEACH BLVD, SUITE 100, LYNWOOD, CA 90262-3340
- **Mailing address phone:** (310) 637-2600
- **Mailing address fax:** (310) 637-2638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | 30715 | CA | Yes |

## Other

- **Enumeration date:** 03/24/2011
- **Last updated:** 03/24/2011