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General NPI Number Information
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NPI Number | 1194452920
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Entity Type | Individual
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Provider Name | DR. ELIANNA MEITAL LARGEMAN
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Gender | Female
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 3808 GENTIAN BLVD
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City | COLUMBUS
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State | GA
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Zip | 31907-1147
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Country | US
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Telephone | 706-322-6581
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Fax | 706-571-8744
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Provider Business Mailing Address
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Address Line | 3808 GENTIAN BLVD
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City | COLUMBUS
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State | GA
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Zip | 31907-1147
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Country | US
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Telephone | 706-322-6581
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Fax | 706-571-8744
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN122814
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122814
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License Number State | GA
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