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NPI Code Detail

MEDICARE: DR. MARK WILLIAM ELICE DMD

MEDICARE: DR. MARK WILLIAM ELICE DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD15810NJ
2122300000XDentistDS043035PA

General Provider Information

NPI Number : 1013999077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK WILLIAM ELICE DMD
Provider Business Mailing Address
First Line : 3223 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5007
Country : US
Telephone Number : 215-707-2890
Fax Number : 215-707-5885
Provider Business Practice Location Address
First Line : 3223 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5007
Country : US
Telephone Number : 215-707-2890
Fax Number : 215-707-5885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 02/24/2023

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Directions to “ DR. MARK WILLIAM ELICE DMD” Practice Location

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