Kerisa Sue Elloway, D.D.S.
Pediatric Dentistry · Fortuna, CA
Practice location
1730 Main StSuite a
Fortuna, CA 95540-2451
- Phone
- (707) 725-1303
- Fax
- (707) 725-1358
NPI record
- NPI
- 1154452324
- Entity type
- Individual (Type 1)
- Enumeration date
- March 8, 2007
- Last updated
- July 8, 2007
- Sole proprietor
- Yes
Specialties & taxonomy codes
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pediatric Dentistry Primary | 1223P0221X |
47254 | CA |
Mailing address
1730 Main St Ste aFortuna, CA 95540-2451
- Phone
- (707) 725-1303
- Fax
- (707) 725-1358
About Dr. Elloway
Kerisa Sue Elloway, D.D.S. is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatric Dentistry (code 1223P0221X). The practice location is 1730 Main St, Suite a, Fortuna, CA 95540-2451. The NPI number 1154452324 was assigned on March 8, 2007 and the record was last updated on July 8, 2007.
Dr. Elloway lists a license in the registry: #47254 (CA) for Pediatric Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.
Frequently asked questions
What is the NPI number of Kerisa Sue Elloway, D.D.S.?
The NPI number is 1154452324.
What is the phone number of Dr. Elloway?
The phone number listed for the practice location is (707) 725-1303.
Where is Dr. Elloway located?
1730 Main St, Suite a, Fortuna, CA 95540-2451.
What is the taxonomy code for Dr. Elloway?
The primary taxonomy code is 1223P0221X – Pediatric Dentistry.
Is this information correct?
All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.