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General NPI Number Information
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NPI Number | 1306322086
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Entity Type | Organization
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Legal Business Name | MARIANA C ELWELL DDS FAGD PC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 6 ATLANTIC ST
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City | BRIDGETON
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State | NJ
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Zip | 08302-1829
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Country | US
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Telephone | 856-455-4095
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Fax | 856-455-5292
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Provider Business Mailing Address
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Address Line | 3129 COUNTRY LN
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City | VINELAND
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State | NJ
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Zip | 08361-8634
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Country | US
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Telephone | 856-506-9351
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIANA C ELWELL
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Credential | DDS
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Telephone | 856-455-4095
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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 | 22DI02582800
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License Number State | NJ
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