Provider Demographics
NPI:1255485942
Name:ELATTRACHE, REID SELIM (DMD)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:SELIM
Last Name:ELATTRACHE
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 1:173 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1324
Mailing Address - Country:US
Mailing Address - Phone:724-942-3133
Mailing Address - Fax:
Practice Address - Street 1:250 OAK SPRING RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2844
Practice Address - Country:US
Practice Address - Phone:724-228-6624
Practice Address - Fax:724-228-8336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026930L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics