Provider Demographics
NPI:1164077046
Name:MACIS, ELIAS ARTHUR (DMD)
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:ARTHUR
Last Name:MACIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 E. 109TH AVE. STE. 3B
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-576-7958
Mailing Address - Fax:
Practice Address - Street 1:9150 E. 109TH AVE. STE. B
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-661-5085
Practice Address - Fax:219-661-5087
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013217A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist