Healthcare Provider Details

I. General information

NPI: 1780503953
Provider Name (Legal Business Name): ELLA MARIE PELAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814-3760
US

IV. Provider business mailing address

4720 ROSEDALE AVE APT 514
BETHESDA MD
20814-3760
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: