Individual
ETHAN MICHAEL ELIZONDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4915 25TH AVE NE, SEATTLE, WA 98105-5667
(206) 524-1600
(206) 524-1603
Mailing address
223 CIRCLE DR, CORPUS CHRISTI, TX 78411-1232
(361) 960-3687
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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