Provider Demographics
NPI:1194853614
Name:ELIA, MAUREEN (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:ELIA
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 NE 194TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2998
Mailing Address - Country:US
Mailing Address - Phone:425-260-5606
Mailing Address - Fax:
Practice Address - Street 1:1130 140TH AVE NE # 100B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2974
Practice Address - Country:US
Practice Address - Phone:425-746-6090
Practice Address - Fax:425-747-9856
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist