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General NPI Number Information
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NPI Number | 1720291917
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Entity Type | Individual
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Provider Name | ELENA AGILINA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 288 STATE ROUTE 35 S
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City | EATONTOWN
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State | NJ
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Zip | 07724-2105
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Country | US
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Telephone | 732-542-7770
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Fax | 732-542-4244
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Provider Business Mailing Address
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Address Line | 9 JAYHAWK WAY
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City | HOLMDEL
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State | NJ
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Zip | 07733-1243
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Country | US
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Telephone | 732-239-5672
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NJ
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