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General NPI Number Information
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NPI Number | 1477845865
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Entity Type | Organization
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Legal Business Name | NIDAL S ELIAS DDS PA
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 9250 BAYMEADOWS RD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1883
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Country | US
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Telephone | 904-731-2120
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Fax | 904-731-9235
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Provider Business Mailing Address
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Address Line | 9250 BAYMEADOWS RD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1883
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Country | US
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Telephone | 904-731-2120
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Fax | 904-731-9235
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Authorized Official
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Title or Position | PROSTHODONTIST
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Name | DR. NIDAL SALEM ELIAS
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Credential | D.D.S.,M.S.
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Telephone | 904-731-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN0011583
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License Number State | FL
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