Provider Demographics
NPI:1003024282
Name:ELMAN, IRA HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:HOWARD
Last Name:ELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963-3109
Mailing Address - Country:US
Mailing Address - Phone:845-386-5121
Mailing Address - Fax:845-386-5531
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4873
Practice Address - Country:US
Practice Address - Phone:845-342-2178
Practice Address - Fax:845-342-6404
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist