Healthcare Provider Details

I. General information

NPI: 1255356598
Provider Name (Legal Business Name): NIDAL S ELIAS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 BAYMEADOWS RD SUITE #300
JACKSONVILLE FL
32256-1883
US

IV. Provider business mailing address

9250 BAYMEADOWS RD SUITE #300
JACKSONVILLE FL
32256-1883
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-2120
  • Fax: 904-731-9235
Mailing address:
  • Phone: 904-731-2120
  • Fax: 904-731-9235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11583
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number11583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: