Provider Demographics
NPI:1215033105
Name:MENENDEZ, ELENA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:M
Last Name:MENENDEZ
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 1:16299 SW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5601
Mailing Address - Country:US
Mailing Address - Phone:954-392-4061
Mailing Address - Fax:
Practice Address - Street 1:16299 SW 54TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5601
Practice Address - Country:US
Practice Address - Phone:954-392-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry