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General NPI Number Information
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NPI Number | 1114503802
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Entity Type | Individual
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Provider Name | ELANA DANIELLE COSTANZA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 3800 N YORK ST
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City | DENVER
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State | CO
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Zip | 80205-3540
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Country | US
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Telephone | 303-296-4873
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Fax |
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Provider Business Mailing Address
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Address Line | 1746 S NEWARK CT
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City | AURORA
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State | CO
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Zip | 80012-5219
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Country | US
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Telephone | 720-366-2409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN-00204972
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License Number State | CO
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