Healthcare Provider Details

I. General information

NPI: 1184302671
Provider Name (Legal Business Name): KEVIN ELLORIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 BRUCE B DOWNS BLVD
WESLEY CHAPEL FL
33544-8612
US

IV. Provider business mailing address

27809 MANOR OAK DR APT 103
WESLEY CHAPEL FL
33544-5379
US

V. Phone/Fax

Practice location:
  • Phone: 813-973-1837
  • Fax:
Mailing address:
  • Phone: 757-348-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: