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NPI Code Detail

MEDICARE: DR. EARL THOMAS ELSTNER JR. D.M.D.

MEDICARE: DR. EARL THOMAS ELSTNER JR. D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry05063VA

General Provider Information

NPI Number : 1851393185
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EARL THOMAS ELSTNER JR. D.M.D.
Provider Business Mailing Address
First Line : 2 COMMONWEALTH PL
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22405-2355
Country : US
Telephone Number : 540-785-4491
Fax Number : 540-786-1015
Provider Business Practice Location Address
First Line : 3511 MEEKINS DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-4894
Country : US
Telephone Number : 540-785-4491
Fax Number : 540-786-1015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 07/08/2007

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