Healthcare Provider Details

I. General information

NPI: 1457810707
Provider Name (Legal Business Name): DE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 CENTRE PARK DR STE 210
COLUMBIA MD
21045-2221
US

IV. Provider business mailing address

8808 CENTRE PARK DR STE 210
COLUMBIA MD
21045-2221
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-9600
  • Fax: 410-772-0830
Mailing address:
  • Phone: 410-772-9600
  • Fax: 410-772-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DOV ELMAN
Title or Position: OWNER
Credential: DDS, MMSC
Phone: 443-756-7887