Provider Demographics
NPI:1093058141
Name:PELZ, ELLEN HOFFMAN (DMD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:HOFFMAN
Last Name:PELZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:HOFFMAN
Other - Last Name:PELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2186
Mailing Address - Country:US
Mailing Address - Phone:414-288-3704
Mailing Address - Fax:
Practice Address - Street 1:1801 W WISCONSIN AVE OFC 129B
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2186
Practice Address - Country:US
Practice Address - Phone:847-702-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001371-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist