Provider Demographics
NPI:1093143802
Name:ANJOO C. ELY, DDS, PLLC
Entity Type:Organization
Organization Name:ANJOO C. ELY, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJOO
Authorized Official - Middle Name:CHAUDHR
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-347-3030
Mailing Address - Street 1:27225 PROVIDENCE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1271
Mailing Address - Country:US
Mailing Address - Phone:248-347-3030
Mailing Address - Fax:248-347-1198
Practice Address - Street 1:27225 PROVIDENCE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1271
Practice Address - Country:US
Practice Address - Phone:248-347-3030
Practice Address - Fax:248-347-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6758910001Medicare PIN