Provider Demographics
NPI:1154453595
Name:DRELICH, ELAINE VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:VIVIAN
Last Name:DRELICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:VIVIAN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:41 CRESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4117
Mailing Address - Country:US
Mailing Address - Phone:607-797-2212
Mailing Address - Fax:607-770-1968
Practice Address - Street 1:41 CRESTMONT RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4117
Practice Address - Country:US
Practice Address - Phone:607-797-2212
Practice Address - Fax:607-770-1968
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0383341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice