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General NPI Number Information
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NPI Number | 1477332039
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Entity Type | Organization
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Legal Business Name | ELITE MEKEL, DMD INC.
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 234 S PACIFIC COAST HWY # 206207
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3383
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Country | US
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Telephone | 818-590-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 152 PALM DR
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-5114
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Country | US
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Telephone | 818-590-2450
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELITE MEKEL
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Credential | DMD
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Telephone | 818-590-2450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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