Provider Demographics
NPI:1114452653
Name:MARCELLE, ELENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:MARCELLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FEDERAL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2867
Mailing Address - Country:US
Mailing Address - Phone:518-272-3221
Mailing Address - Fax:
Practice Address - Street 1:500 FEDERAL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2867
Practice Address - Country:US
Practice Address - Phone:518-272-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046181-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist