Provider Demographics
NPI:1053959247
Name:PHILLIP J ELASSAL DDS PLLC
Entity type:Organization
Organization Name:PHILLIP J ELASSAL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ELASSAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-682-0609
Mailing Address - Street 1:PO BOX 890910
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189
Mailing Address - Country:US
Mailing Address - Phone:405-682-0609
Mailing Address - Fax:405-682-2921
Practice Address - Street 1:1601 SW 89TH STREET #G500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-682-0609
Practice Address - Fax:405-682-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental