# ELDER DENTAL CORP

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

## Provider details

- **NPI number:** 1568905917
- **Authorized official:** MAHR ELDER DDS (OWNER)
- **Authorized official phone:** (415) 890-1190

## Contact information

- **Practice address:** 19 ROTARY WAY, VALLEJO, CA 94591-8475
- **Practice address phone:** (415) 890-1190
- **Mailing address:** 19 ROTARY WAY, VALLEJO, CA 94591-8475
- **Mailing address phone:** (415) 890-1190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 93771 | CA | Yes |

## Other

- **Enumeration date:** 12/01/2016
- **Last updated:** 12/02/2016