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General NPI Number Information
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NPI Number | 1588404487
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Entity Type | Organization
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Legal Business Name | ELIAS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 52975 VAN DYKE AVE STE 301
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-3544
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Country | US
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Telephone | 248-733-5660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70951
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-0018
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Country | US
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Telephone | 248-733-5660
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. KATHY ELIAS
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Credential | DMD
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Telephone | 248-733-5660
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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 |
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License Number State |
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