Provider Demographics
NPI:1225592348
Name:MAEGAN ELAM, DDS AND ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MAEGAN ELAM, DDS AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:RENNA
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-241-3535
Mailing Address - Street 1:2221 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3607
Mailing Address - Country:US
Mailing Address - Phone:817-241-3535
Mailing Address - Fax:
Practice Address - Street 1:2221 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3607
Practice Address - Country:US
Practice Address - Phone:817-241-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598020901OtherDR. MAEGAN RENNA ELAM