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Organization
MERVIN L. ELLSTROM DDS, INC
Active
Organization
MERVIN L. ELLSTROM DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MERVIN L ELLSTROM D.D.S. (OWNER PRESIDENT)
(951) 242-3431
Entity
Organization
Contact information
Practice address
12900 PERRIS BLVD, SUITE 101, MORENO VALLEY, CA 92553-4135
(951) 242-3431
(951) 242-7570
Mailing address
12900 PERRIS BLVD, SUITE 101, MORENO VALLEY, CA 92553-4135
(951) 242-3431
(951) 242-7570
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24928
CA
Other
Enumeration date
04/12/2007
Last updated
01/07/2010
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