Individual
ADAM TAKEO ELLENTHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MPH
Contact information
Practice address
1705 HIGH HOUSE RD, CARY, NC 27513-3601
(919) 267-4211
Mailing address
13308 ENTREKEN AVE, SAN DIEGO, CA 92129-2354
(954) 850-2669
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
111647
CA
1223P0221X
Pediatric Dentistry
PENDING
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/25/2020
Last updated
06/22/2025
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