Provider Demographics
NPI:1083857783
Name:ELSEY, RIINA (DMD)
Entity Type:Individual
Prefix:
First Name:RIINA
Middle Name:
Last Name:ELSEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:RIINA
Other - Middle Name:
Other - Last Name:LOBANOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 MILES RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1950
Mailing Address - Country:US
Mailing Address - Phone:609-792-3237
Mailing Address - Fax:609-792-3237
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:PEDIATRIC DENTISTRY RESIDENCY PROGRAM
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-1020
Practice Address - Fax:215-707-0083
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL100761223G0001X
PADS0382171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice