KERISA SUE ELLOWAY D.D.S.
NPI 1154452324
Dentist - Pediatric Dentistry in Fortuna, CA

Q: What is Kerisa Elloway's NPI number?

The NPI number for Kerisa Elloway is 1154452324. It was assigned to this individual provider in the NPPES registry on March 8, 2007.

Q: What is Kerisa Elloway's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Kerisa Elloway was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 08, 2007

1730 MAIN ST, SUITE A, FORTUNA, CA 95540(707) 725-1303(707) 725-1358 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Kerisa Sue Elloway D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KERISA SUE ELLOWAY D.D.S. (NPI 1154452324) is an individual pediatric dentistry provider in Fortuna, California, licensed in California (47254) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1154452324

Entity TypeIndividualFemale

Primary Taxonomy1223P0221X

Provider Legal NameKERISA SUE ELLOWAYCredential: D.D.S.

Location Address1730 MAIN ST, SUITE AFortuna, CA 95540-2451

Mailing Address1730 Main St Ste AFortuna, CA 95540-2451 · (707) 725-1303 · Fax (707) 725-1358

Phone(707) 725-1303

Fax(707) 725-1358

Sole ProprietorYes

Enumeration DateMarch 8, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1154452324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in CA · 47254

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

1730 MAIN ST, Fortuna, CA 95540

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Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FAMILY FOOT CARE SPECIALIST PODIATRY CENTER

Durable Medical Equipment & Medical Supplies

1730 MAIN ST
FORTUNA, CA 95540

Humboldt County (707) 725-5223

BRETT MICHAEL WONENBERG DDS

Dentist (General Practice)

1730 MAIN ST, SUITE A
FORTUNA, CA 95540

Humboldt County (707) 725-1303

NEIL R KELLEY DPM

Podiatrist

1730 MAIN ST
FORTUNA, CA 95540

Humboldt County (707) 725-5223

FAMILY FOOT CARE SPECIALISTS PODIATRY CENTER INC

Podiatrist (Foot & Ankle Surgery)

1730 MAIN ST
FORTUNA, CA 95540

Humboldt County (707) 725-5223

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kerisa Elloway's NPI number?

The NPI number for Kerisa Elloway is 1154452324. It was assigned to this individual provider in the NPPES registry on March 8, 2007.

Where is Kerisa Elloway located?

Kerisa Elloway practices at 1730 Main St Suite A, Fortuna, CA 95540. The listed phone number is (707) 725-1303.

What is Kerisa Elloway's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Kerisa Elloway was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.