Provider Demographics
NPI:1679712863
Name:STORBECK, ELISA (RDH)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:STORBECK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:SANCHEZ ASCENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:407 S CLAIRBORNE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1744
Mailing Address - Country:US
Mailing Address - Phone:913-648-2266
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020786124Q00000X
AZ6538124Q00000X
KS11086124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist