Provider Demographics
NPI:1679267926
Name:ELTEJAYE, LAYLA
Entity type:Individual
Prefix:MS
First Name:LAYLA
Middle Name:
Last Name:ELTEJAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1703
Mailing Address - Country:US
Mailing Address - Phone:302-357-2496
Mailing Address - Fax:
Practice Address - Street 1:1129 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1703
Practice Address - Country:US
Practice Address - Phone:302-357-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist