Healthcare Provider Details

I. General information

NPI: 1932100252
Provider Name (Legal Business Name): DANIEL OTIS ELLERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISONSIN AVE.
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4909 ALTHEA DR
ANNANDALE VA
22003-4141
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0357
  • Fax:
Mailing address:
  • Phone: 703-503-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS027608L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: