Healthcare Provider Details

I. General information

NPI: 1265171599
Provider Name (Legal Business Name): ELINOR MONAHAN MACLEOD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 FORT RICHARDSON AVE
SAN ANGELO TX
76908-4901
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 325-654-3050
  • Fax:
Mailing address:
  • Phone: 502-852-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10821
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: