Healthcare Provider Details

I. General information

NPI: 1003142324
Provider Name (Legal Business Name): ELENI MICHAILDIIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W 72ND ST #6B
NEW YORK NY
10023-3356
US

IV. Provider business mailing address

124 W 72ND ST #6B
NEW YORK NY
10023-3356
US

V. Phone/Fax

Practice location:
  • Phone: 212-769-4228
  • Fax:
Mailing address:
  • Phone: 212-769-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number054583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: