Provider Demographics
NPI:1093857070
Name:EL-HAGE, ELIE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIE
Middle Name:R
Last Name:EL-HAGE
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 1:13948 LONE RIDER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6431
Mailing Address - Country:US
Mailing Address - Phone:512-294-0005
Mailing Address - Fax:
Practice Address - Street 1:13948 LONE RIDER TRL
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6431
Practice Address - Country:US
Practice Address - Phone:512-294-0005
Practice Address - Fax:512-402-1473
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist