Healthcare Provider Details

I. General information

NPI: 1831629302
Provider Name (Legal Business Name): ELI WILLIAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47301 NATIONAL RD W
SAINT CLAIRSVILLE OH
43950-7798
US

IV. Provider business mailing address

1400 MAIN ST APT 488
CANONSBURG PA
15317-6805
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-5400
  • Fax: 740-695-4998
Mailing address:
  • Phone: 216-333-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025122
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: