Healthcare Provider Details

I. General information

NPI: 1205907003
Provider Name (Legal Business Name): DR. ELIANE JOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 N STATE RD 7 UNIT 14
CORAL SPINGS FL
33073-3307
US

IV. Provider business mailing address

4651 N STATE RD 7 UNIT 14
CORAL SPINGS FL
33073
US

V. Phone/Fax

Practice location:
  • Phone: 954-575-3313
  • Fax:
Mailing address:
  • Phone: 954-575-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901019415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: