Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Michael Elizondo, DDS

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1679288104

Ethan Michael Elizondo, DDS is a Student in an Organized Health Care Education/Training Program in Seattle, Washington. Practices as a sole proprietor. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

4915 25th Ave NE
Seattle, WA 98105-5667
Phone: (206) 524-1600
Fax: (206) 524-1603
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1679288104
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedJanuary 19, 2023
Last updated in NPPESJanuary 19, 2023
Certification dateJanuary 17, 2023
Mailing address223 Circle Dr, Corpus Christi, TX 78411-1232

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